2018 Governor's Awards Nomination Form

Thank you for making a nomination for the Brain Injury Association of Vermont's 2018 Governor's Awards. 
The Awards Ceremony will be on October 9th at our 30th Annual Conference. Winners do not need to be present, however nominees should be in Vermont.

While we recognize that many people deserve recognition, these awards are meant to highlight the extraordinary folks that go above and beyond, for the brain injury community.

If you would like to nominate someone to receive an award, please fill out the information by September 7 
You can nominate one person per category. (You do not have to nominate someone in every category.)

Please write up the reasons you feel this person should receive the award, giving as much information and detail as possible.

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* 1. Nominate an Individual with a Brain Injury: An individual who has assisted other brain injury survivors, has worked at promoting community awareness or support for TBI survivors, and has acted as a mentor for others.

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* 2. Nominate a Caregiver/Support Person: An individual who has made positive contributions in the community by assisting an individual with a brain injury to engage within their community and to be as independent as possible.

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* 3. Nominate Employer: An individual/organization who has hired an individual (or individuals) with a brain injury and has been supportive on the job by making accommodations, etc.. They also advocate in the community and to other employers about the value of employing individuals with brain injuries.

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* 4. Nominate Professional: An individual who has been caring and innovative in the treatment of individuals with a brain injury and advocates for the individual in order to improve the quality of treatment. 

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* 5. Is there anything else you would like to add regarding the person/people you've nominated? 

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* 6. Please enter your contact information.

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