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Annual Awards Nomination Form

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 that has overcome obstacles to become productive in the workplace, please
nominate them for the ‘National Disability Employment Awareness Month’ 2021 Awards Celebration.

Sponsored By:

Disability:IN Uinta County and NextGen Mentoring logo

Nominations Due

September 29, 2021

For more information call 307-783-6302.

Step 1 of 3

2021 Award Nominations

Please indicate below if this nomination is for an Employer or an Employee.
Type of Nomination:*