2021 Nomination Form
How to Submit a Nomination*
Step 1: Highlight and copy the following nomination form (listed after these steps in the section titled 2021 Nomination Form) into a new email message.
Step 2: In that new email message, answer each nomination question.
Step 3: After all nomination questions have been answered, send the email to Disability Rights with the subject line: Martha Glennan 2021.
*Would you prefer to submit your nomination through a form? Download the file** and follow the directions outlined.
**Fairfax County is committed to nondiscrimination on the basis of disability in all county programs, services and activities. To request reasonable accommodations or to receive this information in an alternate format, call 703-324-5868 or TTY 711.
Note: Nomination deadline is Friday, Oct. 15, 2021 by 5 p.m.
2021 Nomination Form
Fairfax Area Disability Services Board’s 2021 Martha Glennan Disability Inclusion and Equality Awards
- Nomination for an individual or organization?
- Name of individual or organization being nominated?
- Type of organization (if applicable): Nonprofit, Government Agency, Business, Other?
- Contact information for individual or organization: Name, Email, Phone?
- Contact information for the person who is nominating the individual or organization: Name, Email, Phone?
Please tell us about this individual or organization’s demonstrated success promoting full inclusion and equality for people with disabilities to thrive in the community.
Based on your/the nominee's work to date, how do you think it has changed or enhanced, and will change/enhance, opportunities for people with disabilities so that they can actively participate in employment, housing, transportation, political, social and/or recreational opportunities within the community?
