Tom Miller Advocacy Award

Recognizes an AbilityOne^® employee with a disability who has made a profound impact by advocating on the local, state, and/or national level for positive policy changes for the disability community.

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

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.

Nominee

First Name *

Last Name *

Preferred Name, if Different

Official Job Title *

Nonprofit Agency *

Time in Their Current Role *

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 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 specific and detailed examples of how your nominee has had a positive impact in the workplace. (Describe the impact the nominee has had on other individuals, the team, and/or the organization. Make sure to include measurable results, lasting changes, moving moments, etc.) *

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. (Make sure to include specific examples.) *

Is there anything else you want us to know about this nominee’s impact? This could include personal stories, testimonials, or additional examples. (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.

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 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 site access, and advance planning requirements with any sites involved in filming.

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 at customer sites (including government or regulated locations) requires advance written approval from the customer via email or other written means, and that filming 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 video 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 and sharing of the video if the nominee is selected.

Please see our Film Production Guide for more information.

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.