Nomination Form

Which Stefanie’s Champions Category are you making a nomination for?

Nominator First Name:
Nominator Last Name:
Nominator Age:
Nominator Address:
Nominator City:
Nominator State:
Nominator ZIP:
Nominator Daytime Phone:
Nominator Evening Phone:
Nominator Email Address:
Nominee First Name:
Nominee Last Name:
Daytime Phone:
Evening Phone:
Email Address:
Provide a detailed description of why your nominee should be chosen as one of the 2014 Stefanie’s Champions.

Please be sure to read the criteria and guidelines for each of the categories (available at the links on the left) before making your nomination.

New for 2014: Nominations can now be made on Facebook:

Supporting materials such as photographs, clippings or letters, should be emailed to or mail to the address below after submitting your nomination. Be sure to indicate the name of your Champion with your materials. We are sorry that originals cannot be returned.

Mail supporting materials to:
Stefanie’s Champions, c/o OSUCCC - James
660 Ackerman Road, 6th Floor
P.O. Box 183112
Columbus, OH 43218-3112.

The Ohio State University Comprehensive Cancer Center – Arthur G. James Cancer Hospital and Richard J. Solove Research Institute (OSUCCC – James) 460 W. 10th Avenue, Columbus, OH 43210 Phone: 1-800-293-5066 | Email: