Impact Award
Exit this survey

1.

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1. Nominee Name:

Nominee Name:

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2. Title:

Title:

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3. Organization:

Organization:

4. Nominee Phone Number:

Nominee Phone Number:

5. Impact Area (Check one):

Impact Area (Check one): Philanthropist

Volunteer

Development/Educational Professional

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6. Please supply the following information regarding your nominee: (500 words or less per question)
1) How does this individual inspire, motivate and contribute?
2) How does this individual’s commitment to faith based education manifest itself? What
impact does that commitment have on your organization?
3) Provide a brief summary of your nominee’s background: education, employment, other
awards, personal or professional milestones.

Please supply the following information regarding your nominee: (500 words or less per question) 1) How does this individual inspire, motivate and contribute? 2) How does this individual’s commitment to faith based education manifest itself? What impact does that commitment have on your organization? 3) Provide a brief summary of your nominee’s background: education, employment, other awards, personal or professional milestones.

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7. Nominated By:

Nominated By:

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8. Nominator Title:

Nominator Title:

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9. Nominator Phone Number and Email:

Nominator Phone Number and Email:

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10. Nominator Organization? Is this Organization a Member of ADC?

Nominator Organization? Is this Organization a Member of ADC?

Impact AwardExit this survey

1.

*1. Nominee Name:

*2. Title:

*3. Organization: