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2026 Achievement Award Nomination

1.Submitter Name
2.Submission Date
3.Nominating Organization
4.Contact Title
5.Contact Email
6.Contact Phone Number
7.Relationship to Nominee
8.Nominee's Name
9.Nominee's Work Email
10.Years Employed at Organization
11.Years at Current Job
12.Current Job Title
13.Location of Work Site
14.In your own words, why are
you nominating this person?
What made them stand out this year?

Provide
information and examples on
why this person stands out amongst their coworkers.
15.Do you have anything that you
can share regarding quotes or
sentiments from co-workers or
supervisors who may want to
say something about your
nominee?
16.How has finding this job been
impactful to your nominee’s
life?
17.Are there any special supports,
technologies, or other factors
that you would like to mention
that has attributed to the
nominee's success?
18.Share how your nominee's
employment journey brought
them to their current position
and success.
19.UniqueSource would like to
share with the Commonwealth
of PA agency partners the
success story of any of their
clients in the workplace. Please
feel free to inform us which
agency (i.e., CILs, OVR, BBVS,
ODP, etc.) we may share your
nominee's success story with.
Please complete this nomination from by April 20, 2026.

Eligibility Requirements:

Individual with a Disability currently working on a UniqueSource contract for at least 6 months
One nomination per organization

Submit General Release Form, and Headshot to Tthompson@uniquesource.com by April 20, 2026. To access the General Release Form, and the Headshot Specifications, please go to the Member Portal in the UniqueSource Documents and Forms Section.

If you experience any issues accessing these documents, please contact Tracy Thompson at Tthompson@uniquesource.com.

Please forward this nomination form to the appropriate team member.