Impact Award Nomination Form

The Midwest Roofing Contractor Association Impact Award recognizes a MRCA Member Company that has demonstrated a commitment to improving the well-being of communities or individuals through philanthorpy or community service demonstrated at a local or national level.

1. Company being nominated must be a current Member of MRCA
2. Contribution (gift or service) must have been performed between September 1 of previous year and September 1 of current year.
3. Must include testimonial(s) from recipient of the gift or service
4. Must include high-resolution photos of company's contribution
Please complete the following information about the company you would like to nominate to receive the MRCA Impact Award.
Complete and accurate information will help the selection committee in making its determination and will likewise assist your nominee in receiving appropriate consideration.

YOUR Information

Your First Name:
Your Last Name:
Your Company:
Phone where you can be reached:
E-Mail for confirmation of receipt:

NOMINEE Information

Nominee's Contact Name:
Nominee's Company:
Nominee's Address:
State: Zip:
Nominee's Phone:
Nominee's E-Mail:

Description of the contribution that the Company being nominated has made:

Who has or will benefit from this contribution?

Testimonial and Photos of Contribution

Nominations are to include a testimonial from the recipient of the contribution. Nominations are also to include a minimum of TWO high-resolution digital photos of the project, nominee, and/or recipient. Preferred file types for photos are pdf, jpg, or eps.

Please send testimonials and photos to Megan Miller at:
- via email
- MRCA 2077 Embury Park Rd. Dayton, OH 45414 via mail
- 937-278-0317 via fax
PLEASE NOTE: Deadline for nominations and the accompanying testimonial and photos is October 1st.
There is no fee for submitting an Impact Award nomination.
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