2020 Heart of Georgia Transition Alliance Champion Awards Nomination Form
The Heart of Georgia Champion Awards and Christmas Gala honors individuals with disabilities and their contributions to the workforce in the Heart of Georgia Region. Nominees can include employees, and/or volunteers. Individuals must reside, work and/or volunteer in one of the following counties in the Heart of Georgia Transition Alliance Region and be a person with a disability. The service county area includes: Bleckley County, Dodge County, Dublin City, Laurens County, Montgomery County, Pulaski County, Telfair County, Wheeler County, Wilcox County and Johnson County. Multiple nominations from each county will be received, however only one champion from each district will be selected to receive the Heart of Georgia Champion Award.
Email address *
Candidate's Full Name *
Parent or Guardian's Name if Minor
Candidate's (Parent or Guardian if Minor) Telephone Number *
School District/County Nominee Represents *
Place of Employment *
Length of Employment *
Supervisor/Owner Email Address *
Superviser/Owner of Business? *
Supervisor/Owner Telephone Number *
Provide a Description of What Makes this Candidate an Outstanding Employee and Champion *
Your Name *
Your relationship to the candidate *
Your email address *
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