Nominate a Prevention Champion
Use this form to nominate an individual, organization, or company who took
action to demand the change to stop a sexually harmful, abusive, exploitive
or violent act or practice. We are looking for acts osf prevention where
individuals, families, communities, artist, or other organizations demanded
the change.
We are also looking for stories where the action taken inspired, or was
catalytic to, a change of heart in another individual or organization. The
person may or may not know the impact their action(s) had.
Those nominated will be considered as feature stories on the website, for
MNCASA Aware awards, and for other possible recognition. Nominees
selected will be asked to give permission for their story or image to be cited.
www.demandthechange.org
Please be as specific as possible. The more
personal and specific an example is, the
more powerful it is for change.
1.
Your name:
Age:
Email:
Phone:
Address:
City:
2.
State:
ZIP:
Name of nominee:
Age:
Email:
Phone:
Address:
City:
State:
ZIP:
3.
The nominee did the following to “demand the change” or to inspire a “change of heart”:
4.
They deserve recognition because:
5.
Please submit this form, pictures, or videos to:
Demand the Change, MNCASA
161 St. Anthony Avenue
St. Paul, MN 55103
Email: demandthechange@mncasa.org
www.demandthechange.org