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2026 Exceptional Employee Nomination Form

For the past 20 years, the Agency for Persons with Disabilities, Vocational Rehabilitation, Blind Services, and other disability organizations have had the honor of awarding outstanding Florida employers as part of the annual October celebration of National Disability Employment Awareness Month.

In addition to nominating and awarding exceptional Florida employers, we are also looking to award outstanding employees with disabilities who have made an impact through employment and leadership. If you are aware of any employees that have made incredible strides through their work, please provide the following information below. Providing detailed information helps the committee in reviewing the nominations. Feel free to elaborate and use as much space as needed.

1.Full Name of employee/nominee:(Required.)
2.Name of the business the nominee is employed at:(Required.)
3.Person of contact for employee/nominee:
4.Phone number to contact employee/nominee:
5.Email to contact employee/nominee:
6.Name of nominator:
7.Nominator phone number:
8.Nominator Email:
9.What city does the employee/nominee work in?(Required.)
10.Describe the work employee/nominee does:(Required.)
11.How long has the employee/nominee been employed at the business?(Required.)
12.Describe how employment has positively impacted the employee/nominee:
13.Describe how the employee/nominee has positively impacted the business and work team:(Required.)
14.How long has the employee/nominee been in the workforce excluding the current position:
15.If known and relevant to the nomination, please describe the individual’s disability and how it relates to their accomplishments or recognition for this award.
16.Share with us a positive moment of impact the nominee has made through employment?