Helping Families & Professionals Connect with Information, Training and Resource Since 1969
 

Nomination For: Outstanding Service Award
Nominations are now being accepted.
Before completing our on-line form below, print and review the guidelines here.
Click here to submit a Letter of Recommendation.
Nominations are now being accepted.
Before completing a Nomination or Letter of Recommendation, print and review the guidelines here.
Click here to submit a Letter of Recommendation.
1)  Nominees Information
Full Name of the person, business or organization:
Address, city,  zip code:
Daytime Phone with area code:
Evening Phone with area code:
Email Address:
Current title or position:
What type of service, program or product etc. does the nominee provide :
 
2)  Nominators Information
First and Last Name:
Your title or position:
Your relationship to the nominee:
Home address, city,  zip code:
Home phone with area Ccde:
Work phone with area code:
Email address:
3)
 Tell us why you think this nominee should receive our “Outstanding Service Award” by answering the question(s)
below.  You can write your answer on you own computer, then “cut and paste” the answers into our on-line form.
a)
 Describe in 1,000 words or less, how the nominee strives to improve the education, employment, or general well being
of students or young adults with a learning disability and/or attention deficit disorder, or for their families.  Provide
specific examples of how the nominee strives to accomplish one or more of the following:
1.        provides a results-oriented LD/ADHD psychological or educational service, program or product;  and/or
2.        serves as a local or state resource provider;  and/or
3.        advocates through legislative or public awareness activities that enhance the general public knowledge
regarding the unique needs, strengths and lifelong potential of individuals with LD/ADHD at school, in the
workplace or living in their community;
4)       who has contributed to the success and mission of the LDA of Indiana.

Each Answer Box will hold up to 500 words each.  Use one or both boxes.
 
 
* Home numbers and email address are required.
Nominees must be a resident of Indiana.

All contact information provided will be treated with confidentially.
Thank you for completing this on-line nomination form.
If your nominee is selected, we will notify you by email.  Award winners will be sent a letter by postal mail.
All nominations not selected will receive an acknowledgement card.

Please review the information before you click on the Submit Bar to send in your nomination.
You'll receive an email notice from us in a day or two to confirm we received the nomination.
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