Robert Schonhorn DSP of the Year Award - Cerebral Palsy Associations of New York State

Robert Schonhorn DSP 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 direct support professional working at a CP State Affiliate whose dedication and effort reflects an exemplary standard of excellence and who has made significant contributions to the quality of life of the people with disabilities they support.

Eligibility

Any direct support professional of an Affiliate whose work has made a lasting and positive difference in the lives of people with disabilities and/or their families. Nominees should embody the values adopted by all CP State affiliates.

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 standard of excellence set by the nominee and actions that reflect this standard:(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