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Don Aldrich Advocacy Award

Nomination Form

The deadline to submit nominations has been extended to 5 p.m. Friday, Sept. 19, 2008. All nominations that have been submitted previously will be considered and do not need to be resubmitted.

Nomination Instructions: Complete the nomination form and use the submit button or mail to the address noted below.

Nominee Information

I hereby nominate:*

Name of business/agency/person:*

Work address:

City: State: Zip:

Home address:*

City:* State:* Zip:*

Phone(s): (W) (H)* Fax:
(Include area code if other than 602.)

E-mail:

Is nominee aware of the nomination?* Yes No (Please mark one.)

Nominator Information

Name:*

Name of business/agency:

Work address:

City: State: Zip:

Home address:*

City:* State:* Zip:*

Phone(s): (W) (H)* Fax:
(Include area code if other than 602.)

E-mail:

Nominations should include:

• A copy of the nominee's resume (Type or copy/paste in the area below or mail in. If mailing in, please note in the text box):*
  

• A list of accomplishments/awards nominee has received (Type or copy/paste in the area below or mail in. If mailing in, please note in the text box).*
  

• In the text box below prepare a 500-word maximum statement telling how the nominee meets the judging criteria (Type or copy/paste in the area below or mail in. If mailing in, please note in the text box).*

  Nominee will be rated on:

  1. Specific advocacy efforts that positively impact people with disabilities in Phoenix.
  2. How the nominee's advocacy efforts have empowered people with disabilities in Phoenix.
  3. Long-term volunteer service and participation on boards and commissions that directly relate to the inclusion of people with disabilities in the Phoenix community.

* required fields

Please return this completed form using the submit button below. If you wish to mail or fax the nomination form to the following address, first press the submit button and print out the submission verification screen that will appear:

Phoenix Mayor's Commission on Disability Issues
c/o City of Phoenix Equal Opportunity Department
251 W. Washington St., 7th Floor
Phoenix, AZ 85003
Attention: MCDI Liaison
Phone: 602-261-8242
Fax: 602-534-1124

Nominations must be received by 5 p.m. Friday, Sept 19, 2008.

Before you submit this e-mail form, we would like you to be aware of the city's policy on the use of its e-mail systems. The policy states that the e-mail message you are about to send: (1) is subject to public disclosure under the Public Records Law, (2) is not private or confidential and (3) is retained for one month.