2016 CCAI Angels in Adoption™ Community Nomination Form
Do you know someone who has improved the life of a child through adoption or foster care? Would you like to honor them for their dedication to improving the lives of children? Nominate them as an Angels in Adoption™ honoree!
First Name of person completing this form:
Your answer
Last Name of person completing this form:
Your answer
Email Address of person completing this form:
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Phone Number of person completing this form:
Your answer
Is your nominee an:
First Name of nominee (or point of contact if an organization):
Your answer
Last Name of nominee (or point of contact if an organization):
Your answer
Nominee Organization (if applicable):
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Nominee Address:
Street:
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City:
Your answer
State:
Zip Code:
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Nominee home phone:
Your answer
Nominee mobile phone:
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Nominee office phone:
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Nominee email address:
Your answer
Member of Congress Information
The Nominee's U.S. Senators and U.S. Representative must be listed accurately in order to submit nomination form. To find the nominee's Senators or Representative please visit www.whoismyrepresentative.com.
Senator 1 First Name:
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Senator 1 Last Name:
Your answer
Senator 2 First Name:
Your answer
Senator 2 Last Name:
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Representative First Name:
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Representative Last Name:
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In what way has your nominee helped children? In this paragraph, you are encouraged to include how they came to be an advocate in the adoption or foster care field, their adoption or foster care journey, and any notable work they have done for adoption/foster care and children. To be accepted the paragraph must be no less than 200 words and no more than 300 words.
Your answer
Please copy and paste the links to any media attention the nominee has received.
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Any special instructions for this nomination?
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