Michigan Developmental Disabilities Council 2012 Award Nomination Checklist

The nomination package must be received through e-mail or postmarked by Wednesday, December 21, 2011. All supporting materials must accompany the nomination package. Supporting materials received separately will not be considered. If you are submitting by e-mail all documents must be electronic, including the supporting materials.
Nomination Guidelines: People without disabilities are eligible to be nominated in all categories except Young Leader. You may not nominate yourself or group for any award. DDC staff and current council members are not eligible for nomination, but can nominate others. 2011 winners cannot be nominated for the 2012 awards in the same category. The awards will be presented February 8, 2012 at the DD Council's Legislative Event.

The nomination package must include the following:

Nomination Checklist Nomination Form Nomination Narrative (Limit of 3 pages)

Supporting Materials (Limit 4 pages)

For example, letter of reference, pictures, press clippings, etc...
A signature is not required for an electronic submission. Your e-mail serves as your signature

Nominator Signature: Date:

If you need help completing the nomination forms please contact the DD Council at (517) 334-6123 by Wednesday, December 1, 2011.

2012 Nomination Form

Award Category
Please check the category of your choice - choose only one box. A nominee can only be nominated in one category. Young Leader Age Unsung Advocate Name: Address: Telephone: Champion Diversity Outreach Organization: (if applicable) City: Zip: Email:

Nominee: (The person you want to win)

Nominator: (The person completing this form)

Name: Address: Telephone: Organization: (if applicable) City: Zip: Email:

References
Please provide two references that know about the nominee's advocacy, outreach or volunteer service activities. References cannot be the nominee, nominator, or a relative of the nominee. Please make these individuals (references) aware they will be contacted. Name: Email: Name: Email: Telephone: Telephone:

2011 Nomination Narrative

In the space below, describe how the nominee meets the criteria for the award category by answering the questions below. The narrative is limited to two (2) pages. Please print or type neatly. Question 1: Why is the nominee deserving of recognition? Provide examples of areas where they have achieved success related to the award category? Question 2: How have their contributions improved the quality of life for people with disabilities?