2023 Achievement Awards Nomination Form

All fields marked with * are required and must be completed.

Each year UniqueSource holds its Achievement Awards and Banquet to recognize outstanding workers from around the state who demonstrate exceptional character in living and coping with disabilities, particularly in the workplace. This year's awards banquet will take place on the evening of Monday, May 8, 2023 at the Harrisburg Hilton in downtown Harrisburg, PA.

The following form is to be used to nominate one employee from your organization working on a UniqueSource contract who has embodied extraordinary qualities that made them stand out this year among your workforce. Approved nominees will be recognized and celebrated awardees at the UniqueSource 2023 Embrace the Abilities Award event. There are three sections to the nomination form:

Organizational and nominee information.
Narrative questions regarding the nominee's accomplishments - to be completed by the person nominating.
Required relase form and photo submission.

You may wish to download this list of questions ahead of time in order to work on your narrative answers in advance of submission.

Please review the guidelines and rules for the nomination below prior to completing the nomination form.

Guidelines and Rules

Nomination must be submitted via online form by an authorized representative of a UniqueSource Member organization.
Only one nomination submission per UniqueSource Member organization.
Nominee should be currently employed by a UniqueSource Member organization.
Nominee must have worked on a UniqueSource contract(s) for a minimum of six of the last twelve months.
Nomination forms and support materials, including release forms, photos, must be received by February 15, 2023.
Nomination forms must be fully completed to be considered for inclusion.
UniqueSource may request additional information and/or clarification of materials submitted through the nomination form.
Awardees are highly encouraged and desired to attend the Achievement Awards Banquet on Monday, May 8, 2023 at the Harrisburg Hilton in Harrisburg, PA.
One awardee will be selected to speak at the Achievement Awards Banquet.
- If selected, your awardee will be asked to participate in a short video presentation about themselves, their job, your organization, and the award nomination. UniqueSource and their production partner may come onsite to your location to record video.
- If selected, your awardee will be asked to accept their award on stage during the Achievement Awards banquet on Monday, May 8, 2023 at the Harrisburg Hilton in Harrisburg, PA. The representative awardee will be invited to speak about their own thoughts regarding the award and to congratulate all of the evening's awardees.

If you have any questions regarding the guidelines and rules, contact Joe Ostrander to discuss.

The Award

The following items and services are included in the UniqueSource Achievement Award package:

An award plaque.
$500 cash gift.
Participation for award recipient and a guest in the UniqueSource Achievement Awards Banquet on Monday, May 8, 2023, including photo shoot, dinner, and two receptions.
One night overnight accommodation on May 8, 2023 at the Harrisburg Hilton to attend the Achievement Awards Banquet, including parking.
Entry for award recipient and a guest to the opening keynote speaker and breakfast at the UniqueSource Member Conference on Tuesday, May 9, 2023.
Inclusion in press releases, social media posts, and/or website posts by UniqueSource in relation to the Achievement Awards.
Entry to optional awardee and guest fun event on Tuesday, May 9, 2023.

Transportation to and from the awards event is the responsibility of the nominee and the nominating organization.

UniqueSource will provide support to facilitiate the participation and attendance of all Achievement Award recipients in the Awards Banquet. Support with transportation needs or any other type of accommodation can be requested by contacting Joe Ostrander.

NOMINATION FORM

Organizational and nominee information

Nominating organization*

Organization full name as registered with UniqueSource, no acronyms.

Nominator contact name*

First NameLast Name

Contact Title*

Contact email*

example@example.com

Contact phone number*

Please enter a valid phone number.

Relationship to nominee*

Nominee's name*

First NameLast Name

Nominee's work email

example@example.com

Years employed at organization*

Years in current job*

Current job title*

Previous positions the nominee held at your organization that contributed to this person's professional development that you would like to mention.

Narrative questions regarding the nominee's accomplishments

This section to be completed by the person listed in the nominator contact section.

Nominee's job description: (provide a short description of the type of employment, duties, responsibilities, and activities of nominee’s job)*

Share relevant information on how your nominee's employment journey brought them to their current position and success.*

In your own words, why are you nominating this person? Why do they deserve to receive the UniqueSource Achievement Award this year? Provide information and examples on why this person stands out and deserves to be celebrated.*

Writing prompts: Is there a single extraordinary event or contribution? Professional development or achievement of note. A promotion. A fantastic team member. An overall star in their role.

Any other accomplishments, contributions, or characteristics does the nominee display in the workplace that have made them stand out from their co-workers? (Be specific and provide examples.)

Has the nominee received a promotion, recognition, or award for their work either within your organization or from an outside entity that you would like to include?

Are there any special supports, technologies, or other factors that you would like to mention that has attributed to the nominee's success?

Describe how the adaptive technology allows the nominee to complete and/or enhance their work? (Be specific and provide examples)

How do you think the nominee’s co-workers might describe them?

Is there any additional information, examples, or stories that are relevant to the nomination?

Additonal Required Information

Release form & photo submission

A signed general release form is required to accompany any photo submission. Download the PDF release form using the link below and fill out the form. This can be done on a computer using Adobe Acrobat or printed and filled out by hand. If completed on a computer, a typed name in a signature box will be accepted.

General photo release form

The Achievement Award nomination requires a headshot photo of the nominee. This will be used in the program book, display posters, program presentation, and in website and social media posts. Ensuring that photos are clear, framed in a way that highlights the subject, and have good lighting is important. The document below provides guidance on acceptable headshots.

Headshot Requirements

Questions on the photo requirements? Contact Joe Ostrander.

Upload signed photo release & and nominee headshot*

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Attach PDF release form and nominee photo in jpg, jpeg, or png format

Thank you for taking the time to submit a 2023 UniqueSource Achievement Awards nomination form. You will receive an email confirmation with the details you submitted. The email will come from UniqueSource Achievement Awards (noreply@jotform.com) check your spam/junk folder if you do not receive the confirmation to your inbox.

You will be contacted if additional information or clarification of the information submitted is needed. See you May.