HUMAN SERVICES ADVISORY COUNCIL, INC
P.O. Box 894 Council Bluffs, Iowa 51502
Email address *
Arlene Steege Award for Human Service Professionals Nomination Form
Deadline: October 31st

Award Guidelines: This award recognizes a person employed in the human service area who demonstrates dedication and commitment to those in need through his/her employment and community service. Nominee’s agency/organization must belong to HSAC.
Nominee’s Name *
Your answer
Job Title
Your answer
How long has the nominee worked for your agency/organization?
Your answer
Does the nominee volunteer anywhere else in the community (service agencies, church, school, etc?)
If YES, approximately how often does the nominee volunteer?
Choose the Qualities this nominee possesses
Compassionate
Honest
Empathetic
Polite
Generous
Tactful
Efficient
Friendly
Humble
Organized
Dedicated
Helpful
Good listener
Trustworthy
Team player
Creative
Hard working
Willing to learn
Leader
Qualities
Explain why this nominee deserves to be recognized for his/her efforts. Include an example of the nominee performing above and beyond his/her job description. Please limit your response to two paragraphs.
Your answer
Nominator’s Name *
Your answer
Nominator's Position *
Your answer
Nominator's Agency/Organization *
Your answer
Nominator's Phone *
Your answer
Nominator's Cell
Your answer
Nominator's Email *
Your answer
* If your nominee is a finalist, you may be contacted to provide further information. Please print this page before clicking submit if you would like a copy of your nomination.
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