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DONATE
About
Find Services
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Resources
Community Health Outreach Project
Our Partners
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Contact
Staff Awardee Questionnaire
Congratulations on being selected as one of your Affiliates’ 2024 Staff Honorees!
We are excited to have you be part of our Annual Conference Award Ceremony this year. Each year, we ask the staff members that will be awarded to fill out a questionnaire to help us tell the story of who you – and the entire group of honorees – are. Please fill out this short questionnaire and submit it by clicking the button below.
Your Name
(As you would like it to appear on your certificate)
Affiliate Name:
Questionnaire
Please contact Kelsey Massyk at kmassyk@cpstate.blackdogsitetesting.com or 518-436-0178 with any questions or concerns.
Tell us your favorite…
Movie:
Movie Genre:
TV Show/Series:
Actor:
Actress:
Director:
Binge-Watching Snack:
If you could choose an actor/actress (past or present/dead or alive) to play you in a movie about your life, who would it be?
What is your favorite part of your job?
(Required)
Max. characters: 500
What was the best day/experience you have had in your current position?
(Required)
Max. characters: 500
Have you ever seen or experienced something that made you think, “This could only happen in the movies!”? If so, what happened?
Max. characters: 500