SECTION 1: Nominator Information
Nominator's Name
(Required)
First
Last
Nominator's Job Title
(Required)
Nominator's Email
(Required)
Nominator's Employer
(Required)
SECTION 2: Nominee Information
Nominee's Name
(Required)
First
Last
Nominee's Employer
(Required)
Nominee's Job Title
SECTION 3: Award Category
Please select one category for which you are nominating the individual or organization:
(Required)
Employer Excellence Champion
Policy Trailblazer Champion
Advocacy All-Star Champion
SECTION 4: Nomination Statement
Describe why you are nominating this individual or organization.
(What sets them apart in supporting family caregivers?)
Detail the policies, programs, or initiatives implemented to support caregivers
(Be specific and provide examples.)
How have these efforts made a measurable or meaningful impact?
(Include any outcomes, feedback, or metrics if known.)
SECTION 5: Supporting Materials (Optional)
Upload any documents, reports, testimonials, or media coverage that support this nomination.
Drop files here or
Select files
Max. file size: 50 MB.