Natalie Rogers Employee of the Year Award - Cerebral Palsy Associations of New York State

Natalie Rogers Employee of the Year 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

Recognizes a staff member from a CP State Affiliate who has set the highest standard of excellence in their support of people with disabilities.

Eligibility

Any employee of an Affiliate whose outstanding efforts and dedication have helped their organization fulfill its mission and who embodies the values adopted by all CP State Affiliates. This includes any employee who is not eligible for the Robert Schonhorn Direct Support Professional of the Year Award or the Susan Constantino Leadership Award.

Nominee Information

Name of Nominee(Required)

Prefix First Last

Nominee Email Address(Required)

Nominee Phone #(Required)

Contact Person Full Name(Required)

Contact Person Email(Required)

Contact Person Phone #(Required)

Describe the contributions the nominee has made:(Required)

How have these contributions improved the quality of life for people with disabilities?(Required)

How has this been emulated?(Required)

Please upload two (2) letters of endorsement from Affiliate staff members or volunteers.

Drop files here or

Max. file size: 128 MB.

Please upload any other appropriate supporting documents.

Drop files here or

Max. file size: 128 MB.

Please upload a photo or photos of the nominee.

Drop files here or

Max. file size: 128 MB.

Nominating Party Information

Nominating Party Name(Required)

First Last

Job Title(Required)

Agency(Required)

Email(Required)

Phone(Required)

Mailing Address(Required)

Street Address Address Line 2 City State ZIP Code