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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, District of Columbia, Georgia, Idaho, Iowa, Kentucky, Louisiana, Maryland, Massachusetts, Michigan, Montana, New Mexico, Pennsylvania, Saipan, Utah, Virginia and Washington.

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.

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

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:
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*
(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
Candidate’s Address
Please check one
Phone Type Other
Candidate Qualifications:
References:
Reference #1
Name*
Reference #2
Name*
Your Information:
Your Name*
 

* Required information

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Your Contact Information
Name*
 

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