Advocate Nomination Form

Nominate an Advocate!
Do you know someone who is a powerful advocate in your community working to make change for themselves and/or others with developmental disabilities?

In honor of Developmental Disabilities Awareness Month, let us celebrate their action in advocacy and accomplishments! This award will be presented at the Arkansas State Capitol Rotunda on March 14, 2023, at the Arkansas Alliance for Disability Advocacy's Annual Pie Day at the Capitol event.

Deadline: March 1, 2023
Category*

Self-AdvocateAlly
Nominee*
Nominee's Email
example@example.com
Nominee's Phone Number

Area CodePhone Number
Why do you feel this person should have their advocacy efforts honored?*
How has this person helped others with developmental disabilities?*
Contact Name*

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

Area CodePhone Number
Should be Empty: