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10th Annual Prince George's Provider Council Employment Awards Celebration

Nomination Form Instructions:

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  • Please use this form to complete nomination for Employees (Persons Supported), Direct Support Professional and Employer/Business Representative. ​

  • Each agency should nominate ONE person in Each category.  If your agency does not wish to nominate someone in a particular category, simply enter "NA" for the questions in that section.

  • Each person nominated will be recognized with an award.

  • All nominations should be written in a person-centered manner.

  • For all long text entries you may upload a file for that entry.  Please identify your name and email in any text document uploaded.  Uploaded documents will not appear on the form but will be accessible to the nominating committee.

  • Nominations are due NO LATER THAN September 13, 2024

Category 1: Name of Employee being nominated ( Employee your agency provides support to):

Does this Employee reside in Prince George's County?

Cat1 -live in PG County
Yes
No - Person being nominated MUST live in Prince George's County.

Address of Employee being nominated:

Why are you nominating this Employee ? (not to exceed 5 sentences)

You may also upload a Word document if preferred. Use 'Upload File' option at the bottom of the form.

Category 2: Name of Direct Support Professional (DSP) Nominated:


Address of Direct Support Professional nominated:

What support has DSP provided?

How does the DSP show excellence in their work?

You may also upload a Word document if preferred. Use 'Upload File' option at the bottom of the form.

Category 3: Name of Employer/Business you are nominating:

Address of the Employer/Business you are nominating:

How has Employer/Business provided great work for individuals with disabilities?

How has Employer/Business provided career opportunities for individuals with disabilities?

You may also upload a Word document if preferred. Use 'Upload File' option below. If uploading a document please include your name and email in the document.

Please upload a picture of the nominated supported employee and/or the nominated DSP below. File format can be an image file or PDF .

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