Susan Constantino Leadership 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 CP Affiliate CEO or other in a leadership role who has set a standard for others to follow and whose dedication has improved the quality of life for people with disabilities. The award honors those whose leadership embodies the values endorsed by all CP State Affiliates and reflects innovative accomplishments which have garnered the respect of others working in the agency.

Eligibility

Any Affiliate Executive/CEO, CFO, COO, or related title in a leadership position. Eligible recipients may range from those who have in the position for only a few years but have already displayed skills and potential that make them stand out to those who have been working in an Affiliate for many years and have made a significant contribution to the agency over those years. Candidates should serve as a role model for new leaders and have a positive impact on the 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)
        Attestation(Required)