The Arc New York 2022 Self-Advocate of the Year Award

2022 Self-Advocate of the Year Award Nomination Form

NOMINATION DEADLINE: Friday, July 22, 2022

About the Award: This award is designed to highlight, recognize and celebrate the achievements and contributions made by The Arc New York’s self-advocates. Nominees and recipients are individuals who not only use services of The Arc New York but also help to shape those services in a manner that benefits other people with intellectual or developmental disabilities. One (1) award in the amount of $500, along with a commemorative personalized glass award is presented annually. All nominees will receive $100 and a certificate of recognition.

Eligibility Criteria:

The nominee must have an intellectual or developmental disability
The nominee must have a connection to a Chapter of The Arc New York Organization
One nomination may be submitted for each county within a Chapter
Previously nominated individuals who have not been recognized may be resubmitted for consideration

Application Requirements:

Completed application
One (1) peer letter of support must be included. Up to two (2) additional letters from others may be included if desired

The Arc New York Self-Advocate of the Year Award will be presented at the October Annual Meeting.

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* 1. Nominee Information

Nominating Chapter

Chapter County

Name of Nominee

Chapter Address

Email Address

Phone Number

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* 2. How has the nominee directly or indirectly helped to enable others with IDD achieve their own personal outcomes (goals/growth)?

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* 3. What groups, boards/committees or other decision-making groups is the nominee involved in?

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* 4. How has the nominee educated the public and other organizations through active participation and interaction? How has the nominee participated in public education or advocacy events?

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* 5. Explain the nominee’s experience in advocating with elected officials and community leaders.

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* 6. What challenges within your Chapter and/or community has the nominee recognized and taken steps towards solving?

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* 7. Contact information for person making this nomination:

Name

Title

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* 8. Digital Signature of person making this nomination - Please type your full name and the date into the field below as your electronic signature (ex. Jane Doe, 8/25/2021)

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* 9. Upload Letter of Recommendation 1

If you don't have a digital copy of your letter available at this time, you can email it separately to the address below

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

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* 10. Upload Letter of Recommendation 2

If you don't have a digital copy of your letter available at this time, you can email it separately to the address below

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.

Choose File

Please email any additional documentation or questions to:

Christina Canino
Special Projects Coordinator
The Arc New York State Office
Email: CaninoC@TheArcNY.org