Nomination for Lifestyle Change Award

The American Heart Association wants to recognize individuals who have made positive changes to improve their quality of life and health. No change is too small, and every accomplishment is significant!

That is why we are now accepting nominations for the 2012 Metro Chicago Lifestyle Change Award, locally sponsored by the University of Chicago Medicine.

Nominations for the Lifestyle Change Award are open to the public. Nominations can be submitted by friends, co-workers or relatives, and individuals can nominate themselves.

Nominations for the Lifestyle Change Award will be accepted through September 7.

*Nominee Name
Company/Worksite
*Phone
*E-mail Address
*Nominated By
*Phone
*E-mail Address
Relationship to nominee
*Which Heart Walk location will you attend? South Cook - Moraine Valley Community College
North/Northwest - Harper College
Downtown Chicago - Grant Park
West DuPage - Esplanade at Locust Point
*Permission to share lifestyle change story: Yes, I give permission to the American Heart Association to share my story. (Please note that an American Heart Association staff person will reach out to you to further discuss your story.)
No, I do not give permission for the American Heart Association to share my story.
I am not the nominee. I am nominating someone else.
In what way has this person improved his/her lifestyle? Please describe the person's accomplishments in the applicable areas below:
Increased Physical Activity
Healthier Eating Habits
Weight Loss
Managing heart--related risk factors such as high blood pressure and high cholesterol
Other
*Personal Story – why do you think this person deserves a Lifestyle Change Award? Did he or she lose weight? Start exercising more? Improve his or her blood pressure? Please include information regarding his or her success.