Business Partnership Award

Honors a small to large commercial business that has partnered with a SourceAmerica-affiliated nonprofit agency to increase employment opportunities for people with disabilities.

Nominations are accepted from SourceAmerica's network of nonprofit agencies and from SourceAmerica employees and senior leadership.

Nominee

Official Name of Organization *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

Name of Contact Person from the Organization *

Job Title of Contact Person *

Email Address *

Telephone *

Nominator

First Name *

Last Name *

Organization *

Official Job Title *

Telephone Number *

Email Address *

Address *

Address 2

City/Town *

State/Province *

ZIP/Postal Code *

CEO Name *

CEO Mailing Address (if different from above)

City/Town

State/Province

ZIP/Postal Code

CEO Email Address *

Please provide the name and contact information for the appropriate Marketing, PR, or Media Relations representative at the nonprofit agency who can support communications, outreach, or media engagement related to this nomination.

Representative Name *

Title *

Organization *

Email Address *

Phone Number *

Please provide the name and contact information for the appropriate representative (sometimes Marketing, or Public Relations) who can assist with media, photography and filming approvals related to this nomination. This may be a representative from the nominee’s employer, the customer worksite, or both if applicable, representing your nominee's employer.

Representative Name *

Title *

Agency/Organization *

Email Address *

Phone Number *

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

Provide a brief overview of the contract/s held by this business partner (products/services provided, number of years this contract has been in place, number of individuals with disabilities employed, etc.) *

Provide a detailed description (with examples) of how this partnership has increased employment opportunities for people with disabilities. *

Provide detailed examples of other positive impacts this partnership has had. *

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

Is there anything else you want us to know about this nominee's impact as a business partner? (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 Impact Awards program.

Slideshow 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 slideshow that will be shared with participants at Xforce, SourceAmerica's national conference, and may be shared on SourceAmerica's social media channels and with other press outlets, and that filming may take place at their workplace, home, or other nearby locations.

I understand that participation will involve coordination with SourceAmerica's production team, including scheduling, filming/photography site access, and advance planning requirements with any sites involved in filming/photography.

I further acknowledge that, if selected, the nominee and nonprofit agency will be required to sign personal media release and promotional release forms, as necessary. I also understand that any filming/photography at customer sites (including government or regulated locations) requires advance written approval from the customer via email or other written means, and that filming/photography cannot take place without this written permission. I understand that sharing the video publicly (outside of the Impact Awards banquet) may also require written permission from the customer and may include edits to the slideshow as a condition to such sharing.

By submitting this nomination, I confirm that I have reviewed these expectations and understand the need to help coordinate filming/photography and sharing of the slideshow if the nominee is selected.

Please see our Film Production Guide for more information.

Eligibility Guidelines *

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