Community Impact Spotlight Nomination Form

We’re celebrating the everyday heroes who make a powerful impact in the lives of individuals with special needs. Whether they are teachers, therapists, volunteers, parents, or advocates — these champions deserve to be recognized! Please fill out the form below to nominate someone who inspires you.

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Email *
Your Name (First + Last Name) *
Please provide as much information as possible on your Nominee. We will reach out to the Nominee to ask for their permission before sharing their story publicly. Please note that in order for us to share their story, you must provide at least ONE of the following for the Nominee: a good, working phone number OR email address. 
Nominee's Full Name (First + Last Name) *
Nominee's Phone Number and/or Email *
Relationship to the Nominee *
Nominee's Role or Title (e.g., Special Ed Teacher, OT, Parent Advocate, Volunteer, etc.) *
Organization or School (if applicable) *
Location of Nominee (e.g., city, state, etc.) *
Why are you nominating this person? Share details if you can. *
What qualities make them stand out? Check all that apply: *
Required
How has this person impacted you or the community? Tell us how they've made an impact in the Special Needs Community. Please share specific examples if you can.  *
Do we have your permission to share your name with the nomination publicly? *
TERMS AND CONDITIONS - 

1. I confirm that I have permission to share this nominee’s name and story provided in this form.
2.  I understand that my submission may be used for social media, website features, or other forms of public recognition.
3.  I release the organizers from responsibility for verifying the permissions I have claimed.
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A copy of your responses will be emailed to the address you provided.
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