Please complete this form to nominate an agency CLIENT for a 2023 Community Action Award. CLIENT nominees may be individuals, couples and families, groups, or organizations, however, in the case of a group award, only one $100 gift card will be given to the selected nominee.*
 
Please complete and submit your nomination form by March 24, 2023. The awards will be distributed at our Michigan Community Action Legislative Day at the State Capitol in the new Heritage Hall in downtown Lansing on May 11, 2023 for Community Action Month. All nominees who are selected by the awards task force will be called forward to receive awards.
 
*In the case of a collective award, as for an organization, MCA can provide certificates for individual members of the organization, but only one gift card will be awarded.

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* 1. Name of Nominee

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* 2. City/Township of Nominee's Residence

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* 3. Has this nomination been approved by your CAA's Executive Director?  (Nominations must be approved by the ED)

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* 4. Nominated by:

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* 5. Email

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* 6. Phone

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* 7. Agency Name

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* 8. Give a brief history of the circumstances that caused the Client to seek assistance from the Community Action Agency.

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* 9. Describe what services were accessed by the Client to overcome barriers to self-sufficiency.

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* 10. Describe the Client’s achievements and successes due to the Community Action Agency services he/she received.

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* 11. Describe the Client’s achievements and successes due to the Community Action Agency services he/she received.

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* 12. Provide any additional information about the Client in support of this nomination.

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