PART 1: NOMINEE OVER VIEW
Nominee Name:
Company Employed By:
Brief Description of Outstanding Achievement, Service to Community or Employer:
Counties Served (if applicable)
PART 2: CONTACT INFORMATION
Nominee Name:
Nominee's Complete Business Address
Nominee's Business Phone
Nominee's Fax
Nominee's Email
Nominee's Home Address
Nominee's Home Phone
Nominator's Name
Relationship to Nominee
Nominator's Complete Business Address
Nominator's Business Phone
Nominator's Fax
Nominator's Email
Nominator's Home address
Nominator's Home Phone
PART 3: CATEGORY SELECTION AND NOMINATION QUESTIONS
Please mark ONE of the following categories for which you are nominating a candidate. Luminary Award for Volunteer Advocate Luminary Award for Professional Advocate Our Advocacy Awards honor individuals who have campaigned for the needs and rights of individuals with disabilities. Two awards will be presented—one for outstanding professional leadership and one for leadership in a volunteer capacity. All Star Award for Outstanding Employee Our Employee Awards honor the outstanding achievements and personal character of workers with disabilities. Nominees should be gainfully employed and demonstrate leadership and empowerment in the workplace. Both supported and competitive employment employees are eligible. Visionary Award for Outstanding Employer Our Business Award honors employers who demonstrate outstanding achievements through supported employment, assistive support, employee integration and promotion of individuals with disabilities. Rising Star Award for Outstanding Tommy Nobis Center Graduate Our Outstanding Graduate Award honors an individual who continues to demonstrate outstanding personal and career achievements since participating in a training program at the Tommy Nobis Center. Galaxy Award for Outstanding Program Our Program Award recognizes specific programs designed to maximize the success of people with disabilities. These programs may be offered through community organizations, schools, state-sponsored groups, churches and any organization providing outstanding programs for individuals with disabilities. Barrier Breaker Award for Innovation This award is for a business, organization, or individual that has acted as a change agent in removing barriers of cultural, policy, or financial significance for individuals with disabilities.
For each category answer the following questions. Please remember, the more thoroughly you complete the nomination questions, the more beneficial for the nominee. How does the nominee stand out as a role model or advocate for people with disabilities? (1 page or less) What makes the nominee uniquely deserving of this honor? Give specific examples of what the nominee does to make a difference in the lives of people with disabilities.(1 page or less) How is this person, company or organization impacting the community? (1 page or less)
PART 4: ADDITIONAL INFORMATION
List Community or Civic Involvement:
Attach Picture of Nominee (for program and event purposes) (optional, MAX 1MB, no more than 1 file)
Attach Articles, Newsletters or Other Support Materials (MAX 1MB each, no more than 3 files)
Attach or Include Letters of Support (MAX 1MS each, at least 1, no more than 3)