NCCDD - Helen C. “Holly” Riddle Distinguished Service Award Nomination Application

Helen C. “Holly” Riddle Distinguished Service Award Nomination Application

The Helen C. “Holly” Riddle Distinguished Service Award is presented to an outstanding North Carolina professional whose work has improved the quality of life for people with intellectual and other developmental disabilities. The award will be presented at the November quarterly meeting of the NC Council on Developmental Disabilities in Cary, NC.

Section 1. Nomination Form

Name of Nominee

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Name(*)

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Home Address

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City

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State

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Zip Code

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Phone Number(*)

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Email

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Section 2. Listing of Qualifications

Please attach as a separate document a brief description (maximum 300 words) of the qualifications of the nominee for this award. Give specific information about the nominee’s activities in improving the lives of people with intellectual and other developmental disabilities, including examples of significant contributions and leadership. Please include the following:

List nominee’s professional experience, contributions and other distinguishing professional characteristics
Areas of strength, leadership and innovation in the area of intellectual and other developmental disabilities
List nominee’s distinguishing personal characteristics, advocacy work and other activities in the area of intellectual and other developmental disabilities

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Section 3. Supporting Information

Identify three individuals who have knowledge of the efforts of the nominee.

NOTE: It is encouraged that individuals submit a short statement (maximum 300 words) in support of the nominee. Statements should include specific examples of work the nominee has done to influence positive change in the lives of people with intellectual and other developmental disabilities.

1.

Name

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Home Address

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City

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State

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Zip Code

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Phone Number(*)

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Email

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2.

Name

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Home Address

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City

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State

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Zip Code

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Phone Number(*)

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Email

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3.

Name

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Home Address

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City

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State

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Zip Code

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Phone Number(*)

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Email

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Section 4. Personal References (Required)

Identify three (3) individuals as personal references who may be contacted to help evaluate the qualifications of the nominee.

Reference 1

Name(*)

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Email(*)

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Reference 2

Name(*)

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Reference 3

Name(*)

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Email(*)

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Nomination submitted by:

Full name

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Organization (if applicable)

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Title/relationship to nominee

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Home Address

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City

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State

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Zip

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Phone Number(*)

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Email(*)

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Section 5. Submission Deadlines and Requirements

I have completed and included the following documents for consideration for the Advocacy and Leadership Awards:

Section 1: CompletedSection 2: Completed with ‘Listing of Qualifications’ (required) attached.Section 3: Completed with ‘Short Statements of Support’ (optional) attached.Section 4: Completed (required)Section 5: Submitted ON OR PRIOR TO, July 14, 2023. Invalid Input

I’ve read and followed the submission guidelines for my application to be considered for the Advocacy and Leadership Awards. I understand my application will not be considered if the following documents are not completed. Invalid Input

Please upload listing of qualifications

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Submission Options: NOTE: all pages of this application must be submitted by Sunday, July 14, 2023 in one of the three ways:

Email the application form to Pam Hunter Dempsey, Systems Change Manager at [email protected] and [email protected]
Fax the completed application to 984-920-8201. Please include cover sheet indicating Full Name and total number of pages.
Mail the application to:
North Carolina Council on Developmental Disabilities
ATTN: NCCDD Advocacy and Leadership Awards, 2010 Mail Service Center, Raleigh, NC 27699-2010

North Carolina Council on Developmental Disabilities - NCCDD

Helen C. “Holly” Riddle Distinguished Service Award Nomination Application

Section 1. Nomination Form

Section 2. Listing of Qualifications

Section 3. Supporting Information

Section 4. Personal References (Required)

Nomination submitted by:

Section 5. Submission Deadlines and Requirements

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