Wesley Rice Youth Advocate of the Year Award Nomination Form

Wesley Rice Youth Advocate of the Year Award Nomination Form

This award is given to a youth with a disability between the ages of 15 and 26 who is a strong self-advocate at school, home or in the community. Nominee must demonstrate leadership by speaking up for themselves and others and is positive role model for young people with disabilities.

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

Please submit via email a photo of the nominee (jpg format) to information@tnstep.org.

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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. Youth's Age:

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* 5. Parent and/or Guardians Name:

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* 6. Please type a short essay describing why this nominee is deserving of the recognition. (Please Note: Do not give confidential information about the youth unless permission has been given from nominee and/or guardian.)

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* 7. Nominated by:

Name

Company

Address

City

State

ZIP

Email Address

Phone Number