2026 Pennsylvania Direct Care Worker of the Year Award Nomination Form

Nomination Form

Please complete all fields on the nomination form. The deadline to submit nominations is August 31, 2026.
Program Eligibility

We are proud to recognize the outstanding contributions of direct care workers who go above and beyond to support clients with compassion, skill, and dedication. Please complete the form below to nominate an exceptional individual for this honor. Licensed disciplines (RNs, LPNs, OTs, PTs, STs) are not eligible. Please limit to two (2) nominations per agency location.

Note: Please make sure each nominee's name is spelled correctly; the spelling submitted on this form will appear on award materials.
Nominee Information
Nominee

First NameLast Name
Nominee Email
example@example.com
Nominee Home Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Years working as a Direct Care Worker/Caregiver
Agency Where Nominee Works
Agency Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
County Where Nominee Works
Please select from list.
Years of Employment with Agency
Nominator Information
Nominator

First NameLast Name
Title
Agency Name
Email
example@example.com
Phone
Format: (000) 000-0000.
Nomination Questions

Please answer the following questions in detail.
What makes this direct care worker exceptional?
(Consider compassion, professionalism, reliability, and impact on clients and families.)
Describe a specific situation that demonstrates the nominee’s excellence.
(Include how the nominee went above and beyond.)
How has the nominee contributed to team spirit, to the industry as a whole, or to the agency’s mission?
Any additional comments or testimonials (from clients, supervisors, or peers):
Should be Empty:

Nomination Form

Nominee Information

Nominator Information

Nomination Questions