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Award Nomination

2004 APSE State Conference “Kaleidoscope of Change”
Coloring the World of Work

Award Nomination Form

Winners in 2003 are not eligible to win in the same category in 2004.  Awards will be presented at the State Conference in October at The Olympia Resort & Conference Center.

We are in search of Job Developer's, Job Trainer's and Supported Employee's that have exhibited creativity and uniqueness while “coloring the world of work”.  Miracles happen every day in the Supported Employment Profession, and we would like to hear about it.

________     Job Trainer - primary responsibility is the coaching of a supported
        employee in a community job site.

________    Job Developer - primary responsibility is the development of community
        jobs for persons.

________    Supported Employee - individual who has to overcome barrier to work in
        competitive employment.

To nominate a “creative person” in one of the above areas, just fill out this form and write a paragraph or two describing their accomplishments and/or successes.

Nominee's Name:
Nominee's Employer:
Job Placement Agency:
Job Title of nominee:
Nominated by:
Relationship:
Contact number or email for person making the nomination:

Due by September 15, 2004
Return to: blohmann@ranchwi.org
Beth Lohmann
Ranch Community Services
W187 N8661 Maple Road, Menomonee Falls WI 53051
Phone: 262-251-8670 Ext. 315
Fax: 262-251-8878