Scott Finney Self-Advocate of the Year Award Nomination Form

Scott Finney Self-Advocate of the Year Award Nomination Form

This award honors a person who has embodied the positive character traits of being a strong self-advocate by accepting responsibility, speaking up for themselves and others, and above all, leading by example. The Scott Finney Self-Advocate of the Year Award is named after a man who has dedicated his life to leading by example.

All nominees will be considered and the recipient chosen to receive the award will be contacted for further information.

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* 1. Submitted:

Date:

Date

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* 2. Information on Nominee:

Name of Nominee

Address

City

State

ZIP

Email Address

Phone Number

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* 3. County:

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* 4. Please type a short essay describing why this nominee is deserving of the recognition. (Please Note: Do not give confidential information about the self-advocate unless permission has been given from nominee.)

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* 5. Nominated by:

Name

Company

Address

City

State

ZIP

Email Address

Phone Number