Self-Advocate of the Year Award Nomination Form
 
 
NOMINATION DEADLINE: Friday, July 21, 2023
 
 
About the Award: This award is designed to highlight, recognize and celebrate the achievements and contributions made by The Arc New York’s self-advocates. Nominees and recipients are individuals who not only use services of The Arc New York but also help to shape those services in a manner that benefits other people with intellectual or developmental disabilities. One (1) award in the amount of $500, along with a commemorative personalized glass award is presented annually. All nominees will receive $100 and a certificate of recognition.
 
 
Eligibility Criteria:
 
  • The nominee must have an intellectual or developmental disability
  • The nominee must have a connection to a Chapter of The Arc New York Organization
  • One nomination may be submitted for each county within a  Chapter
  • Previously nominated individuals who have not been recognized may be resubmitted for consideration
 
Application Requirements:
 
  • Completed application
  • One (1) peer letter of support must be included. Up to two (2) additional letters from others may be included if desired
 
The Arc New York Self-Advocate of the Year Award will be presented at the October Annual Meeting.

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* 1. Nominee Information

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* 2. How has the nominee directly or indirectly helped to enable others with IDD achieve their own personal outcomes (goals/growth)?

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* 3. What groups, boards/committees or other decision-making groups is the nominee involved in?

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* 4. How has the nominee educated the public and other organizations through active participation and interaction? How has the nominee participated in public education or advocacy events?

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* 5. Explain the nominee’s experience in advocating with elected officials and community leaders.

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* 6. What challenges within your Chapter and/or community has the nominee recognized and taken steps towards solving?

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* 7. Contact information for person making this nomination:

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* 8. Digital Signature of person making this nomination - Please type your full name and the date into the field below as your electronic signature (ex. Jane Doe, 8/25/2021)

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* 9. Upload Letter of Recommendation 1

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File

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* 10. Upload Letter of Recommendation 2

PDF, DOC, DOCX, PNG, JPG, JPEG, GIF file types only.
Choose File
Please email any additional documentation or questions to: 

Christina Canino
Special Projects Coordinator
The Arc New York State Office
Email: CaninoC@TheArcNY.org

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