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Ohio Department of Aging Joined Hearts in Giving Award - Nomination Form

The Joined Hearts in Giving Reception was established in 1999 to honor couples who have been married for at least 40 years and volunteer in their communities. The event is held annually in observance of Valentine's Day.?


Selection process - Selection for Joined Hearts in Giving is determined by the total number and geographical distribution of all nominations received. To achieve statewide representation, the Ohio Department of Aging will select honorees from each of twelve geographic regions of Ohio. No more than three couples will be chosen per region. Click here for a map showing these regions.

For help completing this form, click the ? icon for context-specific help.

Criteria:?


Criteria - A nominee must meet all three criteria listed on this nomination form to be considered for the Joined Hearts in Giving Award.
  1. Couple must be married 40 years or longer; at least one of the spouses must be age 60 or older.
  2. Each spouse must actively participate and volunteer in community service.
  3. Couple’s primary residence must be in Ohio.

To nominate someone for induction, simply complete and submit the form below. Alternately, you can download a printable nomination form to fill out and fax or mail in.

All fields, except where noted, are required.?


Nominee information - Please provide all information requested for both the husband and wife. Birthdate information will be used to determine eligibility only and will be shared with the selection committee, but will not be published or shared with any other party or used for any other purpose without the nominee's consent. List up to three volunteer endeavors for each spouse. You may include details of additional endeavors on a separate page.











Where does the husband currently volunteer?
















Where does the wife currently volunteer?


















Write a brief essay (approximately 500 words) describing why you believe this couple should be recognized.?

Essay - Your essay should be no longer than approximately 500 words.





Nominator information - Please provide your contact information. If you are nominating on behalf of an organization, please note so along with your name.








By clicking the submit button below, you certify that the information it contains is accurate and has been verified by all appropriate parties, including the nominees.

Please refer to our Privacy Statement for details about information sent electronically.




Please note: You will be notified if this nominee is or is not selected. Nominations not selected may be resubmitted next year.