|
|
Please complete and submit this nomination form no later than August 4, 2023 at 5:00 p.m. ET. Late, faxed or mailed submissions will not be accepted. Please note the designated word limits for the essay responses as only the designated amount of words will be considered.
If you have additional questions, contact Kim Brussell at info@viscardicenter.org or 516-465-1608.
By submitting an application for these Awards, applicants authorize and approve the use of their name, nomination content, expressions and likeness in marketing, public relations and outreach efforts associated with the Awards program.
*To avoid conflicts of interest, board members and employees of The Viscardi Center and its network of organizations, i.e. Abilities, Inc., Henry Viscardi School, etc., are ineligible.*
|
|
|
Award Nominee Information
|
|
*
|
(Maximum response 255 chars, approx. 5 rows of text)
|
|
*
|
(Maximum response 255 chars, approx. 5 rows of text)
|
|
*
|
(Maximum response 255 chars, approx. 5 rows of text)
|
|
*
|
(Maximum response 255 chars, approx. 5 rows of text)
|
|
|
|
|
*
|
|
|
*
|
|
|
|
Nominator Information (if not the Award nominee)
|
|
|
(Maximum response 255 chars, approx. 5 rows of text)
|
|
|
(Maximum response 255 chars, approx. 5 rows of text)
|
|
|
(Maximum response 255 chars, approx. 5 rows of text)
|
|
|
|
|
|
|
|
|
|
|
|
Essay Questions
These questions may be answered by the individual being nominated or the person submitting the nomination for the Award.
|
|
*
|
|
|
|
|
|
*
|
|
|
|
|
