DBS “Successful 75” Community Advocate Recognition Nomination Form


The Division of Blind Services (DBS) is seeking nominations for the "Successful 75" Awards. Please use this form to nominate a Community Advocate for the “Successful 75” Award. This award recognizes the outstanding efforts of an individual or organization committed to the betterment of persons with visual disabilities. Nominees should be model individuals and/or organizations whose actions have provided inspiration and a lasting impact towards the advancement of the blind and visually impaired community.

The nomination form should only take about 10 minutes to complete. Use the 'Next' and 'Prev' buttons at the bottom of each page to navigate. Click 'Submit' at the end to finish the questionnaire and close your browser. Once you have submitted your nomination form, responses cannot be changed.