2025 NYS Coalition for Children's Behavioral Health - Employee of the Year Application

This prestigious award recognizes the hard work and dedication of your employees. What better way to let them know your appreciation by honoring them at this statewide event on December 2, 2025.

Please complete the nomination form below and include a brief summary as to why you are nominating this candidate. Your summary will be included in a powerpoint shown during the event.

Every member agency program is offered a nomination. Only one nomination per dues-paying program (HCBS, RTF, CR, etc.) is permitted.

This form must be received by 5:00PM on November 14, 2025.

Question Title

* 1. Person Submitting Nomination

Name

Organization

Title

Email Address

Phone Number

Question Title

* 2. Nominee Information

Full Name

Title/Position

Program (HCBS, RTF, CR, etc.)

Organization

Email Address

Question Title

* 3. Please share a brief write-up (limited to 1250 characters) of the nominees accomplishments at your organization. This write-up will be included in the slideshow during the event.

Question Title

* 4. Organization Logo:

Please upload a high resolution PNG, JPEG, JPG or PDF of your organization logo.

PNG, JPG, JPEG file types only.

Choose File

Question Title

* 5. Nominee Photo:

Please upload a high resolution picture or headshot of the nominee listed above. Include the name of the nominee in the file name, please.

PDF, PNG, JPG, JPEG file types only.

Choose File