Ron Cowell Award 2021

2021 Ron Cowell Award Nomination Form
The State Interagency Coordinating Council for Early Intervention is looking for nominations for:

The 2021 Ron Cowell Award for Excellence in Service to Young Children with Disabilities and their Families.

Eligibility: an individual who has significant impact on Early Intervention public policy development, Early Intervention practices, or staff development such as: parents, providers of Early Intervention Services, higher education personnel, public policy makers, philanthropists, and others dedicated to Early Intervention.

Nomination Requirements: Please complete and submit the entire nomination form, including three letters of recommendation and an explanation of why the nominee is deserving of the Ron Cowell Award. Optionally, you may also submit the nominee's resume and/or a list of the nominee's substantial accomplishments.

Nomination information and/or questions should be sent to: Gina Federico at gfederico@pattan.net

All nominations are due by February 28, 2022

Nominator Information
Name*

First NameLast Name
Email*
example@example.com
Phone Number*

Area CodePhone Number

Nominee Information
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*

Area CodePhone Number
Email*
example@example.com
Program Affiliation*
Number of Years in Early Intervention*
Why is your nominee deserving of the Ron Cowell Award?*

Letter of Recommendation 1*

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Letter of Recommendation 2*

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Letter of Recommendation 3*

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Optional: Other forms of substantiation of accomplishments

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Optional: Other forms of substantiation of accomplishments

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Should be Empty: