FHK Learning Initiative: Award Recipient Form FHK Initiative Award Recipient Form Thank you for your dedication, and congratulations on your award! Please complete this brief form to help us recognize your achievement, continue to raise funds for the initiative, and inspire others. Name * Name First Name First Name Last Name Last Name Safer Society Foundation would like to recognize applicants and award recipients by sharing limited, non identifying information (for example: your name, professional title, organization name, city/state/province/country, and your personal statement and career motivations) on our website, in reports to donors, and in other promotional materials for the Fay Honey Knopp Learning Initiative. Please know that we will not share any sensitive, personal, or confidential details from your application. Do you consent to Safer Society Foundation using this limited information for these recognition and promotional purposes? * Yes No How would you like your name to appear? * Would you be willing to provide a photograph for use on our website, social media, and promotional materials? * Yes, I will upload a photo No, I prefer not to share a photo File Upload Drop a file here or click to upload Choose File Maximum file size: 52.43MB Please share a brief statement about what being selected as a Fay Honey Knopp Learning Initiative award recipient means to you. * (Optional) LinkedIn Profile URL, if you’d like us to tag you in a post: (Optional) Any additional comments or feedback: Submit If you are human, leave this field blank. Δ
