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Scott Finney Self-Advocate of the Year Award Nomination Form
This award honors an individual who has demonstrated exceptional self-advocacy by taking responsibility, speaking up for themselves and others, and leading by example. This award recognizes a person who embodies the core values of advocacy through their actions, showing determination, courage, and a commitment to creating positive change. Named after Scott Finney, a man who dedicated his life to leading by example, this award celebrates those who, like him, inspire others through their strength, resilience, and unwavering advocacy for themselves and their communities.
Date
Nominees Name
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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
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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
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