DR. TEMPLE GRANDIN DISTINGUISHED SERVICE AWARD
NOMINATION FORM-2004
 
Nomination Guidelines: Thank you for taking the time to nominate an individual whose work with children and/or adults with autism epitomizes excellence. Nominees must work in San Diego County. At this time those who volunteer, but do not perform paid work, are not eligible for nomination. Nominees may work in public schools, private schools, residential programs, respite care, or any other direct support capacity. Employees of TERI, Inc., or their family members, are also not eligible for nomination.
 
INFORMATION ABOUT YOU (Nominator):
     
First Name  
Last Name  
Address 1  
Address 2  
City  
State  
Zip  
     
Phone 1  
Phone 2  
     
What is your relationship to the person you are nominating?  
If other, please explain  
     
Who can we call to support this person’s nomination?     (employer, supervisor preferred) 
     
First Name  
Last Name  
Position  
Phone  
 
INFORMATION ABOUT THE PERSON YOU ARE NOMINATING (Nominee):
     
First Name  
Last Name  
Address 1  
Address 2  
City  
State   California
Zip  
Approximate number of years nominee has worked with children/adults with autism?  
     
Nominee’s Employer  
Employer Phone  
     
How has this nominee demonstrated excellence?  
     
What makes this person exceptional?  
     
      
 

Thank you for your nomination. The award winner will receive $250 and free admission to our conference. The award will be presented at our annual Autism Through The Lifespan Conference on April 30, 2004 at the Hyatt Islandia Hotel in San Diego. Winners and nominators will be contacted by phone a week prior to the conference and informed of the committee decision.

 

Design: Matt Luckey Illustration & Design