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Scott Finney Self-Advocate of the Year Award Nomination Form
This award honors a person who has embodied the positive character traits of being a strong self-advocate by accepting responsibility, speaking up for themselves and others, and above all, leading by example. The Scott Finney Self-Advocate of the Year Award is named after a man who has dedicated his life to leading by example. All nominees will be considered, and the recipient chosen to receive the award will be contacted for further information.
Date
Nominees Name
*
First Name
Last Name
Nominees Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nominees County
*
Nominees E-mail
*
Nominees Phone Number
*
-
Area Code
Phone Number
Nominees Cell Number
-
Area Code
Phone Number
Short essay describing why this nominee is deserving of recognition.
*
Please Note: Do not give confidential information about the self-advocate unless permission has been given from nominee).
0/250
Include a photo of the nominee (jpg format)
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Nominated by:
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
CLICK HERE to submit your nomination
Should be Empty: