Die Hard Award Nomination Form

Nominees must demonstrate some or all of these characteristics:

Excellence in advocacy toward Self-Determination and Self-Direction principles, activities, and outcomes.
Excellence in leadership on systems change in areas of community living, employment, housing, healthcare, education, and technology that enhance the lives of individuals with disabilities and their families throughout Wisconsin.
Sets a high standard of excellence that promotes values of independence, productivity, inclusion, and self-determination for people with disabilities and their families.
Commitment to growing Self-Advocacy in Wisconsin.
Commitment to ensuring people in unserved or underserved communities from diverse cultural and economic backgrounds have a voice.

*Submit your completed nomination no later than August 14, 2024*

Die Hard Award Nomination Form

Please Check One:

Professional Advocate
Self-Advocate / Grassroots Advocate

Nominee's Name:

Nominee's Email

Nominee's Phone Number

Nominee's Address

Role/Job Title:

Years of Service:

Nominator's Name:

Nominator's Phone Number

Nominator's Email

Nominator's Address

Affiliation to Nominee

Nomination Narrative Questions

1. Tell us how the nominee has demonstrated leadership, creativity, and expertise that have benefited others and/or their community. Describe his/her accomplishments and commitment to advocacy.

2. Tell us why the nominee is a positive role model for others.

3. Share one story or example that demonstrates why this person is a Diehard .

Only one nomination per nominator per category (professional advocate/self-advocate/grassroots advocate)

Signature:

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