CAREERS ABOUT US SUPPORT RAUCH PROGRAMS INDUSTRIES EVENTS BLOG ANNUAL REPORT 2022 IMAGINE AWARDS DOWNLOAD FORM 2022 Imagine Awards Nomination Form Guidelines Please print or type all information. Be as specific and detailed as possible. The more legible and specific the information, the greater chance your nominee will have to be selected for an Imagine Award. The references you provide may be contacted as a part of the judging process. Nominees must work and/or live in Clark, Floyd, Harrison, Scott or Washington Counties in Indiana or Jefferson County, Kentucky. A description of the award categories is listed below. · 2022 Imagine Award for an Individual with a Disability. This award is given to a person with a disability for outstanding personal achievements. · 2022 Imagine Award for a Community Leader/Citizen/Volunteer. This award acknowledges those whose actions have had a positive impact upon the lives of persons with disabilities. The individual is recognized for his/her ongoing commitment to improve the lives of persons with disabilities through personal and/or professional efforts. · 2022 Imagine Award for a Business/Organization. This award is given to a business or organization that has shown a consistent commitment to employ or enhance the lives individuals with disabilities in the workplace and in the community. Nominee Name/Business:____________________________________________________________________________ Address:____________________________ City:_____________________ State:______ Zip:_________ Contact:_________________________ Home Phone:_____________ Work Phone:___________________ Nominee’s Place of Employment:_______________________________ E-mail:________________________ Nominating Organization/Individual Name/Business:_____________________________________________________________________________ Address:____________________________ City:____________________ State:______ Zip:__________ Phone:______________________ Fax:___________________ E-mail :________________________ Award Category (circle one): Individual Community Leader Business Signature of person making the nomination:________________________________________________________ I consent to the judging process and, if selected as a winner, will attend the 2022 Imagine Awards at Caesars Southern Indiana on 3/5/2022 to accept the honor. If the event is virtual, I agree to be available in advance of the event to tape the award presentation and my remarks. Signature of nominee:__________________________________________________________________________ COMMUNITY LEADER OR BUSINESS NOMINATION QUESTIONS Rationale for making an Imagine Awards Nomination The information that you provide will determine if your nominee is selected and is very important to the judges. Instructions: Please print or type all information, keep answers short and concise, and use no more than two pages to answer the four questions provided. Two additional pages of attachments may be supplied as supporting documentation. IMPORTANT! THE FOLLOWING QUESTIONS ARE FOR NOMINATING A COMMUNITY LEADER OR BUSINESS. PLEASE SEE THE FOLLOWING PAGE IF NOMINATING AN INDIVIDUAL WITH A DISABILITY. 1. Briefly describe your nominee’s experiences working with and/or advocating for individuals with disabilities. 2. What activities exemplify your nominee’s efforts to help build “a community where everyone belongs”? 3. List any other civic activities in which your nominee may be or has been involved. 4. Provide a brief synopsis summarizing why your nominee should be considered for an Imagine Award. Please submit no later than December 31, 2021 to: Development Office Rauch, Inc. 845 Park Place New Albany, IN 47150 Phone: 812-945-4063 - Fax: 812-941-8820 devcoord@rbralliance.org Thank you for taking the time to nominate a deserving individual or organization. INDIVIDUAL WITH A DISABILITY NOMINATION QUESTIONS Rationale for making an Imagine Awards Nomination The information that you provide will determine if your nominee is selected and is very important to the judges. Instructions: Please print or type all information, keep answers short and concise, and use no more than two pages to answer the four questions provided. Two additional pages of attachments may be supplied as supporting documentation. IMPORTANT! THE FOLLOWING QUESTIONS ARE FOR NOMINATING AN INDIVIDUAL WITH A DISABILITY. PLEASE SEE THE PRECEDING PAGE IF NOMINATING A COMMUNITY LEADER OR BUSINESS. 1. Briefly describe your nominee’s diagnosed disability or disabilities and how this has impacted his or her life. 2. List activities and accomplishments of your nominee. 3. How does your nominee help build “a community where everyone belongs”? 4. Provide a brief synopsis summarizing why your nominee should be considered for an Imagine Award. Please submit no later than December 31, 2021 to: Development Office Rauch, Inc. 845 Park Place New Albany, IN 47150 Phone: 812-945-4063 - Fax: 812-949-0830 devcoord@rbralliance.org Thank you for taking the time to nominate a deserving individual or organization. CONNECT @rauchinc on twitter Rauch, Inc. • 845 Park Place • New Albany, IN 47150 • (812) 945-4063 View Privacy Policy Powered by Squarespace