Employer of the Year Nomination Form

Please give us your contact information.

Your Name (required)
Your Phone (required)
Your Address

Your Email (required)

Name of Employer/individual you are nominating:

Please provide the employer's address, phone number, contact name and email address
Contact Name
Contact Address

Contact Phone
Contact Email

Please describe the industry or business focus of the employer you are nominating.

Please describe activities this employer is engaged in that enhance employment opportunities for individuals with disabilities (please include specific examples, quantify the level of impact those activities have had, and provide the number of individuals with disabilities that are employed).

Please describe the level of community involvement this individual/employer has within the disability community (please include specific examples of involvement and quantify the level of impact those activities have had).

Please describe what environmental (or physical location) barriers this employer has removed to increase employment opportunities for individuals with disabilities (please be specific).