Disability Inclusion Award Nomination Form

Disability Inclusion Award

Have you witnessed acts of kindness or inclusion in the Village of Arlington Heights? The Commission for Citizens with Disabilities would like to hear from you! Let’s recognize our neighbors that create a more welcoming and accessible community for people with disabilities. No act of kindness is too small. Please submit your nominations below in the Jotform. We will highlight these stories throughout the year and select one outstanding nominee to receive formal recognition at a special celebration. “Kindness is the language which the deaf can hear and the blind can see.” -Mark Twain
- Name of Nominee (Individual, Group, Business, Agency, etc.)*
- Relation to Nominee*
- Reason For Nomination*
  Describe why you are nominating this individual or group for Disability Inclusion Award.
- AdvocacyKindnessInclusionLeadership
- Nominee's Phone Number
  
  Area CodePhone Number
- Nominee's E-mail Address
- Nominee's Address
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Your Name*
  
  First NameLast Name
- Your E-mail Address*
- Your Phone Number*
  
  Area CodePhone Number
- Your Address*
  
  Street Address
  
  Street Address Line 2
  
  CityState / Province
  
  Postal / Zip CodeCountry
- Any additional information you would like to include
  Describe why you are nominating this individual or group for Disability Inclusion Award.
- Should be Empty: