Community Distinction Award
Please nominate an individual or organization from the community who works hard to support our vision for an inclusive community. This can be for a one-time good deed (a legislator who takes a stand for people with disabilities) or for a longer term commitment (neighbors who are just generally supportive). The award is for those outside of ASN who show compassion and empathy for our cause.
Sign in to Google to save your progress. Learn more
Your Name *
Your Email *
Your Phone Number *
Nominee Name *
Nominee Email *
Nominee Phone Number *
How do you know this nominee? *
This award can be given based on a one time good deed or for a longer term commitment.  Please share a story that demonstrates why this nominee should be considered for this award. *
Please describe ways this nominee has worked hard to create inclusion for people with disabilities in our local and/or statewide communities. *
If you could thank this nominee for the work they do, what would you say?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Arkansas Support Network. Report Abuse