Public Service
1.
Please enter the information indicated below.

First Name:
Last Name:
Work Phone:
Email Address:
emailaddress@xyz.com
Nominee's Name:
Nominee's Address:
Nominee's Telephone:
Nominee's Email:
Submitted by- Individual or Organization:
On behalf of:

2.
This award is presented to individuals or groups in the public eye who make special efforts to increase understanding of people with developmental disabilities and/or advocate for improvement of services that are available to people with disabilities.  Potential nominees may include elected representatives, government officials, community leaders, or the media.
 

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