DAWN Ontario: DisAbled Women's Network Ontario

 

The Kim McConnell
INCLUSION LEADERSHIP AWARD

 


NOMINIATION FORM

Nominations must be received by Sept. 30, 2004


For each nomination please complete the following information. Type or print clearly.


Nominee's name__________________________________________________________
(may be an individual, organization, or group)


Address_________________________________________________________________
(home or business-circle one)


City________________________________Prov.__________________PC___________


Tel: (Please include area code)

(home) _________________________ (work)__________________________________

E-mail_________________________________


Nominee is: (check one)

[    ]     an individual
[    ]     an organization
[    ]     a group

If organization or group: Contact name Phone #: _________________________________


Job title of Nominee (if appropriate)___________________________________________


Nominator's name_______________________________________________________


Address________________________________________________________________


City________________________________Prov__________________PC__________


Tel: (Please include area code)

(home) _________________________ (work)__________________________________

E-mail_________________________________


Your relationship to nominee (employee, co-worker, friend, etc.)____________________


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Inclusion is people with disabilities and people without disabilities participating together in all life activities - at school, at work, at home, at worship, in the community.

This nomination is in the area of (check one only):

[    ]     Community Inclusion: This nominee has demonstrated inclusion by creating opportunities for people with disabilities to fully participate in and contribute to community and public life - including in community events and activities; leisure, sports and recreation; living environments; politics; or by providing accessible businesses, services and facilities.

[    ]     Educational Inclusion: This nominee has demonstrated excellence in providing education that is truly inclusive, where students with or without disabilities are educated together, and individual needs are accommodated in a rich and dynamic learning environment.

[    ]     Religious Inclusion: This nominee has demonstrated commitment to and inclusion of people with disabilities as active participants in worship, in the life of the congregation and in fellowship. Welcoming practices and physical accommodations are both important to inclusion.

[    ]     Workplace Inclusion: This nominee has demonstrated inclusion by promoting and supporting the full participation of qualified persons with disabilities in the workplace, including through fair and equitable employment practices and/or by providing innovative workplace design and solutions.

[    ]     Outstanding Achievement: This nominee is a woman with disability whose life and performance reflects integrity, passion and an ongoing commitment to the right of people with disabilities to belong and be a part of all that goes on in our communities.

Please answer the following. Type or print clearly. Read all questions before beginning.


1) This nominee deserves recognition for the following reasons:


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2) Give three concrete examples of how this nominee supports inclusion of people with disabilities.

·

·


·



3) How long has the nominee engaged in or promoted inclusive practices? Have practices changed overtime, if so describe:







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4) Give one example of what others can learn from this nominee about including people with disabilities:





5) Is inclusion part of the nominee's regular daily operation or job responsibilities?

Yes_____ or No_____ If "yes," please explain.




Note: While it is not necessary to send any additional information for a nomination, you may supplement your nomination by including up to five additional pages that give specifics and supports your nomination as "best inclusion practice." We cannot return any materials sent. All materials must clearly indicate, on each piece sent, the nominee's name, the nominator's name, and date.

Please read the entire Nomination form before answering any questions. Make your nomination no later than mid September to ensure it is received by Sept. 30, 2004. Address to:

DAWN Ontario
Kim McConnell Inclusion Leadership Award
Box 1138
North Bay, ON
P1B 8K4

If you have questions please email dawn@thot.net

 

download the Nomination Form in the following formats:

download the Brochure in the following formats:
(prints on 8 X 14 inch paper - landscape - 4 panels)


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