Tom Miller Advocacy Award

Recognizes an AbilityOne® employee with a disability who has demonstrated outstanding achievement and remarkable passion for self-advocacy on a local, state, and/or national level.

Nominations are accepted from SourceAmerica's network of nonprofit agencies.

Nominee

First Name *

Last Name *

Preferred Name, if Different

Official Job Title *

Nonprofit Agency *

Time in Their Current Role *

Is this nominee an AbilityOne employee?

Note: An AbilityOne employee is defined as someone who is employed on a current AbilityOne contract. If a subcontractor, as part of the SourceAmerica Prime Vendor program, is a nonprofit agency affiliated with SourceAmerica, their employees are considered AbilityOne employed and may qualify for this award.

Yes

*If you answered "no" to this question, your nominee is not eligible for this award.

Nominator

First Name *

Last Name *

Official Job Title *

Organization *

Phone Number *

Email Address *

Address of the Organization *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

CEO of the Organization *

CEO Mailing Address (if different from above)

CEO Mailing Address 2

City/Town

State/Province

ZIP/Postal Code

Please respond to the prompts below. The first four are required for this award.

Provide a detailed overview (with examples) of your nominee’s achievements. *

Provide a detailed description (with examples) of your nominee's passion for advocacy, including their advocacy for policies that positively impact employees with disabilities. *

Provide detailed examples of your nominee's advocacy activities on the local, state, and/or national level. *

Provide a detailed description of why your nominee is an ideal candidate to win this award. *

Is there anything else you want us to know about this nominee? (optional)

Supporting Documents

Add up to three supporting items to strengthen your nomination. Examples include: press releases, news stories, work samples, videos, internal or external reviews, etc.

Supporting Documents

Up to three files can be uploaded to this field.
20 MB limit.
Allowed types: gif, jpg, jpeg, png, bmp, eps, tif, pict, psd, txt, rtf, html, odf, pdf, doc, docx, ppt, pptx, xls, xlsx, xml, avi, mov, mp3, ogg, wav, bz2, dmg, gz, jar, rar, sit, svg, tar, zip.

Acknowledgments

Nominee Notification *

By checking this box, I am confirming that the nominee has been notified of their nomination as an entrant in the Achievement Awards program.

Video and Promotional Activities *

By checking this box, I acknowledge that the nominee is aware that if they are selected, they will be featured in a video and that filming may take place at their workplace or nearby locations. I also acknowledge that if my nominee is selected, they are aware that the nonprofit agency, the nominee, and anyone who is featured in the slideshow video may be required to sign a promotional media release and a personal media release, as applicable. For more information, review our required Promotional Release and Personal Media Release forms, which can be provided to the nominee upon request.

Photo *

By checking this box, I acknowledge that if my nominee is selected as a finalist, my organization will be required to submit a headshot of them for promotional purposes.

Eligibility Guidelines *

By checking this box, I acknowledge that I have reviewed the eligibility guidelines.