Section 1. Nomination Form
Section 2. Listing of Qualifications
If necessary, please attach as a separate document a brief description (not to exceed 300 words) of the qualifications of the nominee for this award. Give specific information about the nominee’s activities in improving lives of people with intellectual or other developmental disabilities, including examples of significant contributions and leadership. Please include the following:
- List nominee’s advocacy experience
- Areas of strength/experience/achievements in the area of intellectual or other developmental disabilities.
- List nominee’s volunteer experience
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.
Section 4. Personal References (Required)
Identify three (3) individuals as personal references who may be contacted to help evaluate the qualifications of the nominee.
Section 5. Submission Deadlines and Requirements
Submission Options: NOTE: all pages of this application must be submitted by Friday, July 30, 2021 in one of the three ways:
- Email the application form to Philip C. Woodward, Systems Change Manager, at firstname.lastname@example.org and email@example.com
- Fax the completed application to 919-715-0325. 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