2008 GALAXY OF STARS NOMINATION FORM Instructions Complete one form for each nomination. You may submit nominations in multiple categories. Answer ALL questions for each category for which you have a nomination. There are four sections to this nomination application form. For judging purposes, each question is assigned a specific value, so please do not omit any section. Nominees from previous years may be re-nominated. Please update your responses before submitting an application form. Please type or neatly print your responses for a total of no more than three pages. All applications AND support documents must be received by 5 p.m. on February 11, 2008. Please return your application via email or US mail to: Galaxy of Stars Nominee Tommy Nobis Foundation 1480 Bells Ferry Road, Marietta, GA 30066-6014 stacyo@tommynobiscenter.org Fax: 770.499.9191 2008 GALAXY OF STARS NOMINATION APPLICATION FORM
2008 GALAXY OF STARS NOMINATION FORM
Instructions
Galaxy of Stars Nominee Tommy Nobis Foundation 1480 Bells Ferry Road, Marietta, GA 30066-6014 stacyo@tommynobiscenter.org Fax: 770.499.9191
2008 GALAXY OF STARS NOMINATION APPLICATION FORM
PART 1: NOMENEE OVER VIEW Nomenee 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 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 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 who 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 specifics 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 or 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)
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 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
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 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 who 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.
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)