CP Emerging Leader Award Nomination Form

Please fill in the form below and submit when complete.

Should you require a PDF of this form to fill out manually, please contact Kelsey Massyk at kmassyk@cpstate.blackdogsitetesting.com to request a downloadable copy.

 

Purpose

Honors a CP Affiliate Staff Member who has demonstrated leadership skills that identify them as one of tomorrow’s CP leaders. Critical components of their skills are collaboration, innovation, peer support, and willingness to take part in a wide range of projects to fulfill the Affiliate’s mission.

Eligibility

Any CP Affiliate staff member who exhibits leadership skills and the potential to be a leader in the disability field in the future. Eligible recipients should display a commitment to disability issues and have demonstrated their aptitude for leadership through specific projects and accomplishments that have improved the organization’s capacity to fulfill its mission of supporting people with disabilities. Candidates should serve as a role model for other staff at Affiliate and within the community.

Nominee Information

Name of Nominee(Required)
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        Nominating Party Information

        Nominating Party Name(Required)
        Mailing Address(Required)