Community Action Impact Award

Community Action Impact Award Nomination Form
This award recognizes an existing employee of the Community Action Network who, through excellent leadership, has positively and significantly impacted a specific community or the Network at large and works to promote greater economic opportunity for children and families. The individual’s leadership had transformed their CAA, department, or program and contributed to their community becoming a better place to live. Nominees for this award must be employed for at least three years by a Community Action Agency in a leadership role.
Nominee's Contact Information
Nominee Name*

First NameLast Name
Nominee's Organization*
Nominee's Position/Title*
Nominee's Phone Number*
Nominee's Email*
example@example.com
Please briefly describe the qualities, characteristics and/or factors you feel make the nominee the ideal candidate for receiving the award:*
Examples of Meeting Criteria
Site at least two specific examples demonstrating the nominee’s leadership skills and impact.
Example 1*
Example 2*
Letters of Support

Provide two support letters describing why the nominee should receive the award. These letters of support should come from someone other than the nominator.
Upload Letters of Support*

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Supporting Documentation

Include supporting documentation, if appropriate, including news stories, newsletter articles, etc. (Please note:all attachments shall not exceed 5, 8.5”x11” documents)
Upload Supporting documentation

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Your Contact Information
Your Name*

First NameLast Name
Relationship to Nominee*
Your Phone Number*
Your Email*
example@example.com
Does the Nominee know that he/she has been nominated?

YesNo
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Community Action Impact Award Nomination Form

Nominee's Contact Information

Examples of Meeting Criteria

Letters of Support

Supporting Documentation

Your Contact Information