Annual Awards Nominations

2015 Annual Award Nomination Form

At our 2015 Annual Meeting and Awards Dinner on Thursday, October 22, 2015, at the La Fontaine Bleue in Glen Burnie, Maryland, the Maryland Network Against Domestic Violence will recognize individuals and organizations that have made a significant contribution toward the elimination of domestic violence. Awardees who are chosen are selected for their exceptional efforts in working towards the elimination of domestic violence in Maryland by working effectively and collaboratively within the domestic violence community to positively impact victims and survivors.

All entries must be received by July 31, 2015.

Please note that the award categories have recently changed! Please provide complete and accurate information that is as detailed and specific as possible. Awardees will be carefully chosen by the Nomination Review Committee, which is composed of members of the MNADV Board of Directors and the Executive Director.

Question Title

* 1. Please enter the information for the person you are nominating:

Name of Nominee: *

Company/Organization/Agency (if applicable):

Title:

Address: *

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

Question Title

* 2. For which award category is this person being nominated?

LEADERSHIP AWARD: Selected nominee(s) will have a demonstrated track record and successes in leading statewide, regional, or community-based systems advocacy efforts that aim to improve the response to domestic violence and that works toward the elimination of domestic violence.

DOMESTIC VIOLENCE SERVICE PROVIDER AWARD: Selected nominee(s) will have a demonstrated track record as a staff member or volunteer at an organization that provides direct services to victims/survivors who goes above and beyond the job description to make a difference.

COMMUNITY PARTNERS AWARD: Selected nominee(s) will have a demonstrated track record as a staff member, volunteer, or community member that has provided exceptional support to the domestic violence community and/or to victims/survivors themselves. This may include people within health care, education, law enforcement, criminal justice, social services, faith-based organizations, the local business community, media, or other related fields.

Question Title

* 3. Which individual (or group) is nominating the person for the award?

Primary Contact for Nomination (Name): *

Program/Organization/Agency (if applicable):

Title:

Address: *

City/Town: *

State: *

ZIP: *

Email Address: *

Phone Number: *

Question Title

* 4. Why are you nominating this for person for an award? What is it about their accomplishments, personality, work ethic, track record, etc. that makes this person an exemplary nominee? (5-7 sentences)

Question Title

* 5. Please provide a short biographical description of the person's background, which may include their education, profession, work history, or other information that is relevant to the nomination. (5-7 sentences)

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* 6. Name one or more specific examples, successes, or anecdotes that demonstrate how this person meets the criteria for the award category that you selected above. (5-7 sentences)

Question Title

* 7. In what ways does this person work as an active participant in the domestic violence community? How and with whom do they collaborate within the community? (5-7 sentences)

Thank you for submitting a nomination!