2019 Governor's Awards Nomination Form

Thank you for making a nomination for the Brain Injury Association of Vermont's 2019 Governor's Awards. 
The Awards Ceremony will be on October 8th at our 31st 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 27th 
You can nominate one person per category. (You do not have to nominate someone in every category.)

PLEASE INCLUDE A NAME AND SHORT PARAGRAPH ON WHY YOU THINK THE NOMINEE SHOULD RECEIVE THE AWARD, GIVING AS MUCH DETAIL AS POSSIBLE. 


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* 1. CATEGORY: Individual with Brain Injury
 
Someone 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.

PLEASE INCLUDE A NAME AND SHORT PARAGRAPH ON WHY YOU THINK THE NOMINEE SHOULD RECEIVE THE AWARD, GIVING AS MUCH DETAIL AS POSSIBLE.

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* 2. CATEGORY: Caregiver/Support Person

Someone 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.

PLEASE INCLUDE A NAME AND SHORT PARAGRAPH ON WHY YOU THINK THE NOMINEE SHOULD RECEIVE THE AWARD, GIVING AS MUCH DETAIL AS POSSIBLE.

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* 3. CATEGORY: Employer

An individual/organization who has hired an individual (or individuals) with a brain injury and has been supportive of 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.

PLEASE INCLUDE A NAME AND SHORT PARAGRAPH ON WHY YOU THINK THE NOMINEE SHOULD RECEIVE THE AWARD, GIVING AS MUCH DETAIL AS POSSIBLE.

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* 4. CATEGORY: Professional

Someone who has been caring and innovative in the treatment of individuals with a brain injury and advocates for the individual to improve the quality of treatment.

PLEASE INCLUDE A NAME AND SHORT PARAGRAPH ON WHY YOU THINK THE NOMINEE SHOULD RECEIVE THE AWARD, GIVING AS MUCH DETAIL AS POSSIBLE.

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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. Should the person(s) you nominated be chosen, we might contact you for additional information.

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