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Austin Disability and Employment Awards - Employee of the Year Nomination Form

Please complete the form below to nominate someone for the Austin Disability and Employment Awards Employee of the Year award. Information is subject to the Public Information Act.

If you have questions, you can contact Dolores Gonzalez or mail your questions to the Austin Mayor's Committee for People with Disabilities at:
P.O. Box 1088
Austin, TX 78767-8834

Phone: 512-974-3256
TTY: 512-974-2445
Fax: 512-974-3296

Nominator Information
Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)
Enter the ten-digit fax number, including the area code. (Example: 123-456-7890)
Include your complete e-mail address, including the '@' symbol. (Example: name@example.com)
Nominee Information
Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)
Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)
Enter the ten-digit fax number, including the area code. (Example: 123-456-7890)
Include your complete e-mail address, including the '@' symbol. (Example: name@example.com)
Nominee's Employer Information
Enter the ten-digit phone number, including the area code. (Example: 123-456-7890)
Enter the ten-digit fax number, including the area code. (Example: 123-456-7890)
Enter the complete e-mail address, including the '@' symbol. (Example: name@example.com)
Describe how the nominee has overcome his or her disability to become an outstanding employee and role model for others with disabilities.
Describe the nominee's activities and accomplishments that would merit this distinguished award.
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