Better Hearing and Speech Month Recognition Award Nomination Form

Hamilton Relay enjoys the opportunity to give back to the communities we serve each year during Better Hearing and Speech Month. Each May we recognize leaders within states where we are the contracted relay and/or captioned telephone service provider. This includes California, Colorado, Connecticut, District of Columbia, Georgia, Idaho, Illinois, Indiana, Iowa, Kentucky, Louisiana, Maine, Maryland, Massachusetts, Michigan, Minnesota, Mississippi, Montana, Nebraska, Nevada, New Mexico, New York, Oklahoma, Oregon, Pennsylvania, Rhode Island, Saipan, South Carolina, Tennessee, Utah, Vermont, Virginia, Washington, Wisconsin and Wyoming.

We are looking for individuals who are hard of hearing, late-deafened or have difficulty speaking, and who demonstrate strong leadership, volunteerism and involvement within his/her community. Award recipients are honored during the month of May and will be featured on the Hamilton Relay website and under the Awards tab of the Hamilton Relay Facebook page.

Or you can download the MS Word document or download the PDF and submit the completed form to your State’s Outreach Coordinator or directly to Hamilton Relay’s corporate office:
Email: info@hamiltonrelay.com
Fax: 402-694-5110
Mail: Hamilton Relay, 1006 12th Street, Aurora, NE 68818.

For more information, contact your state outreach coordinator

Candidate Information:

Name of Candidate*

First Name

Last Name

(Please note that this award is presented to one individual within your state each year. Organizations, schools, associations, groups of individuals, and individuals who are deceased are not eligible for this award.)

The candidate

is hard of hearing

is late-deafened

has difficulty speaking

Candidate’s Address

Address (Line 1)

Address (Line 2)

City

State

Zipcode

Phone Number

Please check one

Voice

TTY

CapTel

VP

Phone Type Other

Other

Please Specify Other

Email Address

Candidate Qualifications:

How has the candidate been active and/or made an impact in his/her community? Please focus primarily on providing information pertaining to the volunteer efforts and accomplishments he/she has done outside of his/her career and/or regular job duties.*

List the complete names of associations, organizations, clubs or other activities in which your candidate has been involved. Include position(s) held, term length and any other pertinent details.*

What are the strongest points about the candidate?*

Please feel free to include additional information as needed.

References:

Reference #1

Name*

First Name

Last Name

Phone Number*

Email Address*

Reference #2

Name*

First Name

Last Name

Phone Number*

Email Address*

Your Information:

Your Name*

First Name

Last Name

Phone Number*

Email Address*

Submit Nomination

* Required information

Better Hearing and Speech Month Recognition Award Nomination Form

To nominate someone in your state, complete and submit the online form below by April 8, 2022

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