HDSA Awards Nomination Form 2019
Please fill in the form by Friday, February 1st, 2019. Thank you!
Email address *
NOMINATOR'S CONTACT INFORMATION
First Name *
Your answer
Last Name *
Your answer
Phone Number (Only to be used if HDSA needs to get in touch with the nominator regarding their nomination) *
Your answer
NOMINEE'S CONTACT INFORMATION
Who are you nominating?
First Name *
Your answer
Last Name *
Your answer
Residing City
Your answer
E-mail
Your answer
Phone Number (if no e-mail provided)
Your answer
All award descriptions can be found here: https://www.haltondownsyndrome.com/get-involved/hdsa-awards/
I nominate the above person for an HDSA Award in the following category (choose only 1):
If the above person is honoured with this award, who should present it to them? (In the interest of time, we ask that only 1 person, or 1 VIP & Support Person, present the award)
Describe the above nominee's service or contribution to the HDSA Community including any activities or examples to illustrate. *
Your answer
Describe how the nominee's contribution has benefited the lives of an individual or individuals with Down syndrome. *
Your answer
Describe how the nominee's leadership has helped promote the acceptance and inclusion of people with Down syndrome. *
Your answer
Nominators may consider including the following: (not required)
1. A photo of the nominee
2. Up to 2 testimonials from others who have benefited from the individual's contribution
3. Any other relevant documentation (photos, news articles, etc.)
If interested, you may e-mail any of the above recommended files to office@haltondownsyndrome.com.
Submit
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of Halton Down Syndrome Association. Report Abuse - Terms of Service