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Community Leader Award

Hamilton Relay recognizes an individual in each Hamilton Relay contracted state who is Deaf, DeafBlind, hard of hearing, late-deafened or who has difficulty speaking and demonstrates strong leadership and volunteerism within the community. Additionally, an individual or organization that demonstrates leadership and volunteerism in the Deaf, DeafBlind, hard of hearing or speech difference community may be nominated for this award.

To nominate someone in your state, complete the form below.

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

Nominee/Organization Information:
Nominee/Organization’s Address
Please check one
Phone Type Other
The Nominee
Nominee Qualifications:

References:

Please list two references (other than yourself) and their contact information.

Reference #1*
Name*
Reference #2*
Name*

Your Information:

Please include your contact information.

Your Name*
 

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Your Contact Information
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