Community Action Impact Award Nomination Form
This award recognizes an individual, agency, or department within New York’s Community Action Network whose leadership and innovative contributions have created meaningful, lasting change. Nominees should demonstrate a deep commitment to expanding opportunity and access through work that strengthens a CAA, department, program, partnership, or the broader Network. Individual nominees must be employed for a minimum of three years by a Community Action Agency.
Nomination Deadline: Friday, August 7, 2026.
Nominee's Contact Information
Nominee Name
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First Name
Last Name
Nominee's Organization / Agency / Department
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Nominee's Position / Title (if applicable)
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Nominee's Phone Number
*
Format: (000) 000-0000.
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:
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Examples of Meeting Criteria
Cite at least two specific examples demonstrating the nominee’s leadership skills and impact.
Example 1
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Example 2
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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)
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Your Contact Information
Your Name
*
First Name
Last Name
Relationship to Nominee
*
Your Phone Number
*
Format: (000) 000-0000.
Your Email
*
example@example.com
Does the Nominee know that they have been nominated?
Yes
No
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