2025 UniqueSource Achievement Awards Nomination Form

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

"It is nice to know it [my work] does not go unnoticed, as I do take pride in what I do.” - Chuck Gottus of Blind & Vision Rehabilitation Services of Pittsburgh, a 2024 Achievement Awards recipient

At UniqueSource, we want to recognize and celebrate the extraordinary accomplishments of your employees who inspire us every day with their dedication, resilience, and exceptional work. This year, we invite you to honor the best of the best—those who:

Love coming to work.
Go above and beyond in their roles.
Embody perseverance by overcoming barriers.
Demonstrate exceptional character in living and coping with disabilities.

We will honor your nominee during the Embrace the Abilities Awards Banquet, held on:

🗓 Wednesday, May 21, 2025
📍 Hershey Lodge & Convention Center, Hershey, PA

How to Nominate:
Use the short nomination form to spotlight one standout employee from your organization. Please ensure that your nominee:

Is currently employed by your organization.
Has worked on a UniqueSource contract for at least six months.

Don’t forget to include a photo of your nominee with the submission!

Nominate Today!

Let’s celebrate their hard work, achievements, and incredible stories together.

For more details, including nomination guidelines and rules, refer to the end of the nomination form.

How we will celebrate your nominee

We want to honor your nominee for the Achievement Award in a big way. They are special to you, and to us. To let your nominee know how special they are, we hold a big award ceremony and dinner banquet for them and two additional guests of their choice. We also give them the following things and experiences:

An award plaque.
$500 cash gift.
Participation for award recipient and two guests in the UniqueSource Achievement Awards Banquet on Wednesday, May 21, 2025, including photo shoot, pre-reception, dinner, and after-party.
One night overnight accommodation on May 21, 2025 at the Hershey Lodge to attend the Achievement Awards Banquet.
Inclusion in press releases, social media posts, and/or website posts by UniqueSource in relation to the Achievement Awards.
Entry to optional fun event enjoying some of Hershey's attractions on the morning of Thursday, May 22, 2025 for the awardee and two guests.

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

UniqueSource will provide support to facilitate 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 at jostrander@uniquesource.com.

NOMINATION FORM

Organizational and nominee information

Nominating organization*

Organization full name as registered with UniqueSource, no acronyms.

Nominator contact name*

Contact Title*

Contact email*

Contact phone number*

Please enter a valid phone number.

Relationship to nominee*

Nominee's name*

Nominee's work email

Years employed at organization*

Years in current job*

Current job title*

Location(s) of work site:*

Narrative questions regarding the nominee's accomplishments

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

In your own words, why are you nominating this person? What made them stand out this year? Why do they deserve to receive the UniqueSource Achievement Award over their fellow co-workers? 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 – what was it and why is this so special? Professional development or achievement of note. A story illustrating why they are a fantastic team member. Specific reasons why they are an overall star in their role.

Do you have anything that you can share regarding quotes or sentiments from co-workers or supervisors who may want to say something about your nominee?*

In addition to your nomination responses, please provide any insights you can share regarding:

How has finding this job been impactful to your nominee’s life?

Writing prompts: Has it contributed to their independence, skill development, social life, financial stability, overall wellbeing, or in some other positive way?

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

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

Writing prompts: Were they referred by an agency, answered a job ad, originally came for services? What has been their path within your organization? Did they work prior to coming to your agency? Provide as much detail as possible.

UniqueSource would like to share with the Commonwealth of PA agency partners the success story of any of their clients in the workplace. Please feel free to inform us which agency (i.e., CILs, OVR, BBVS, ODP, etc.) we may share your nominee's success story with.

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.

Click here to download General photo release form

The Achievement Award nomination requires a photo of the nominee. Ideally, the photo should make your nominee happy with what is being submitted. Do they have a favorite photo?

Because the photo will be used in the awards program book, on display posters, in program presentation, and in website and social media posts, it also needs to be clear and have a good resolution. The photo should highlight your nominee and have good lighting.

For tips and guidance on providing a quality photo can be found by downloading our Photo Guide by clicking here.

Questions on the photo requirements? Contact Joe Ostrander at jostrander@uniquesource.com.

Upload signed photo release & and nominee headshot*

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

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 must 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 January 31, 2025.
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 Wednesday, May 21, 2025 at the Hershey Lodge & Convention center in Hershey, PA.
Awardees may be selected to speak at the Achievement Awards Banquet.
- If selected, your awardee may 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 may be asked to accept their award on stage during the Achievement Awards banquet on Wednesday, May 21, 2025 at the Hershey Lodge & Convention Center, Hershey, PA. The representative awardee may 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 at jostrander@uniquesource.com to discuss.

Thank you for taking the time to submit a 2025 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 in May.