Annual Awards Nomination Form - Disability IN: Uinta County, WY

For more information call 307-783-6302.

September 23, 2024

Recognizing outstanding employers for their contributions
toward hiring individuals with disabilities and celebrating
individuals who have overcome barriers to succeed in the workplace.

If you know of employers who promote employment opportunities for persons with disabilities and/or an individual with a disability who has overcome obstacles to become productive in the workplace, please nominate them for the ‘National Disability Employment Awareness Month Awards Celebration.

Nominations Due

"*" indicates required fields

2024 Award Nominations

Please indicate below if this nomination is for an Employer or an Employee.

Type of Nomination:*

Employer Nomination

Employee Nomination

Name of Nominee:*

Company:*

Address:*

City:*

Zip Code:*

Phone Number:*

Company Representative:

If this is an employee nomination, how long has the employee worked at this business?:*

Person Making This Nomination

As the person making the nomination, please complete the information below.

Your Name:*

Title:

Name of Organization:

Your Phone Number:*

REASON(S) FOR THIS NOMINATION

“Why are you nominating this business or individual?”*

(Please indicate the reason(s) you're nominating this employer or employee)