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Access and Inclusion Award Nomination Form
Indianapolis Mayor's Advisory Council on Disability
2008 Access and Inclusion Award Nomination Form
To print this form: Select Print This Page from the options at the bottom of this page.
To download an electronic version, please click here. (Requires Adobe Acrobat Reader.)
Please Check the Appropriate Box
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2008 James Pauley Lifetime Service Award: The James Pauley Lifetime Service Award was established in memory of James K. Pauley, who was one of the founders of the Indianapolis Mayor's Advisory Council on Disability and it's Chairperson from 1978 to 1980. Mr. Pauley worked with the Indiana State Department of Natural Resources to survey state parks for accessibility and acted as a consultant in the design of Pauley-Glover Commons apartments. Mr. Pauley was also active in the fight against hemophilia and volunteered with the Indiana State Division of Disability, Aging and Rehabilitative Services. The level of service, advocacy and dedication that Mr. Pauley demonstrated is most often only aspired to, but the recipient of this award should be an individual who demonstrates outstanding contributions promoting the inclusion and independence of persons with disabilities.
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2008 Accessibility Award: The Accessibility Award is designed to recognize individuals, businesses, and organizations that have made exceptional contributions to ensure persons with disabilities can participate in events, programs and activities offered in Indianapolis. Contributions to any and all aspects of community life such as in art, culture, recreation, leisure, commerce, travel, worship and social life are considered.
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2008 Employer Award: The Employer Award is designed to recognize individuals, businesses, and organizations that demonstrate an extraordinary commitment to providing training and career opportunities to persons with disabilities that promote inclusion. |
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* Required Fields |
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Name of nominee or contact person* |
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Nominee's organization or company |
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Address including City, State & Zip Code |
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Telephone Number including Area code* |
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Name of Person Submitting Nomination* |
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Organization or company name of
person submitting nomination |
___________________________________
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Telephone number including area code* |
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Please provide a statement supporting the nomination on separate stationary. We must also have an electronic version of the separate statement, which you can email to jpaini@indygov.org. The statement should include a description of the individual, business or organization that is being nominated and events or actions that warrant recognition. Indicate how the nominee promotes the inclusion of persons with disabilities in Indianapolis and why you believe your nominee should receive the particular award for which the nomination is made. Please feel free to duplicate this form for multiple award nominations. Nominations are due by Friday, May 23, 2008. Late or incomplete applications will not be considered. To submit a nomination, forward this form and your statement to: Juli Paini, Coordinator, Indianapolis Office of Disability Affairs, City County Building, Room 2360, 200 E Washington Street, Indianapolis, IN 46204, or at fax 327-4577. Again, the electronic version must be submitted to jpaini@indygov.org.
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