Community Action Personal Achievement Award

Community Action Personal Achievement Award Nomination Form
This award recognizes a current or former Community Action participant or customer who has achieved significant personal accomplishments. The individual demonstrates a genuine commitment to persevere despite obstacles or disability. They work hard, are a positive influence, show appreciation, and are dedicated to helping themselves and others. This award is not intended for staff persons.

The winner of this award will be reimbursed up to $300.00 for expenses related to attending the conference to accept his/her award compliments of NYSCAA.
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 relevant to the nominee’s commitment to achieving accomplishments despite barriers.
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, certificates of achievement,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
Should be Empty:

Community Action Personal Achievement Award Nomination Form

Nominee's Contact Information

Examples of Meeting Criteria

Letters of Support

Supporting Documentation

Your Contact Information