Formulário de Nomeação de Erik Poliak

Help us recognize outstanding community members.

Please nominate individuals whose dedication, service, and positive impact truly reflect the spirit of the Eric Poliak Award.

Eligibility:

Nominations are open to American citizens resident in São Paulo or, alternatively, to members of the American Society of São Paulo community who have made meaningful contributions. Nominees should demonstrate a sustained commitment to service, a positive impact on others, and alignment with the values of the Society.

Would you like to submit this nomination anonymously or with your name?

Anonymously

Named

First name

Last name

Phone

Nominee

Name

Briefly describe the nominee’s contributions and why they should be considered for the award.

Additional Information. Please share any further details that may help the committee better understand the nominee’s contributions. This could include specific initiatives, achievements, or examples of their impact on the community.

Supporting Materials (Optional)

I declare that the information submitted is true and correct to the best of my knowledge and reflects a genuine assessment of the nominee’s contributions.

Confidentiality & Data Protection

Any personal data you provide about yourself or the nominee will be kept strictly confidential and will not be shared with the nominee or published without your explicit consent. All information will be securely stored and processed in accordance with Brazil’s LGPD (Lei Geral de Proteção de Dados – Law No. 13.709/2018).

Consent

By submitting this form, you confirm that you agree to provide this information and understand that it will be handled confidentially in line with the terms above.