"Rehabilitant of the Year" Nominations
Please answer the following questions to submit a nomination for Arkansas Rehabilitation Association's Rehabilitant of the Year Award.

Deadline: April 1, 2019

Person making nomination: *
Your answer
Office Location and Telephone Number of person making nomination: *
Your answer
Nominee's Name *
Your answer
Nominee's Date of Birth:
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Nominee's Home Address:
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Nominee's Home Phone:
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Nominee's Employer: *
Your answer
Nominee's Job Title:
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Nominee's Business Address/Phone Number:
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Describe Nominee's disability and tell how and when their disability was acquired - *
Your answer
Describe Nominee's rehabilitation - *
Your answer
Explain what training, experience, and support enabled nominee to perform his or her activities: *
Your answer
Explain what difficulties the nominee has encountered due to their disability related to employment and how these difficulties have been overcome or accommodated. (Explain the nominee's initiative, resourcefulness, and perseverance in overcoming these difficulties) *
Your answer
Explain how the nominee has shown ingenuity in adapting to his or her work and living environment - *
Your answer
Describe the nominee's present involvement in areas affecting people with disabilities in the community - *
Your answer
What job accommodations, if any, had to be made to the individuals work site?
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Outline the nominee's employment background:
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How has this nominee helped facilitate rehabilitation and/or employment of other people with disabilities?
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List other accomplishments not covered in the previous questions:
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Electronic Signature of person submitting nomination. (Please type your initials) *
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