2017 NCSEA Innovative Partnership/Collaboration Award Application

1. Program Overview & Nominee Information

The 2017 NCSEA Innovative Partnership/Collaboration Award recognizes innovation in partnership between a child support agency and any other group(s) that assists families. This includes, but is not limited to, collaborations between a child support agency and court or another agency, organization, or program serving parents, families or children.

If the nominator is NOT the IV-D Director, he/she must indicate as to whether they have shared the recommendation with the State IV D Director.

At least one public sector individual (excluding the individual being nominated for the award) must be the nominator or additional references.

Please be sure to complete all questions.

To assist the NCSEA awards committee in evaluating nominees, please respond to the following questions. Nominees must provide the necessary information to substantiate or support your answers to the questions regarding the nomination.

If you have questions about the application, please contact Chris Williams, NCSEA Executive Director, at (703-506-2880) or chriswilliams@ncsea.org.

Question Title

* 1. Please provide us with the following information about the agency you are nominating:

Title of Program Awareness Project

Agency/Organization:

Primary Contact:

Address 2:

City/Town:

State/Province:

ZIP/Postal Code:

Email Address:

Phone Number:

Question Title

* 2. Please provide us with the following information about you.

Name:

Agency/Organization:

Address 1:

Address 2:

City/Town:

State/Province:

ZIP/Postal Code:

Job Title:

Email Address:

Phone Number:

Question Title

* 3. Please provide us with the following information the individual seconding the nomination.

Name:

Agency/Organization:

Address 1:

Address 2:

City/Town:

State/Province:

ZIP/Postal Code:

Job Title:

Email Address:

Phone Number:

Question Title

* 4. If the IV D Director is not submitting or nominating this award submission, is the IV D director aware of the submission?

Yes