The Carter Catlett Williams Award for Excellence in Aging
or Long-term Care Services Nomination Form

Criteria: The nominee must be:


• A professional staff member within an organization providing services for older adults (e.g. community-based provider, housing facility, home care provider).


• The nominee must not be working within the acute health care setting (hospital).

Fill in the form below and click at the bottom to submit your nomination for the Carter Catlett Williams Award. *All fields are required.

I am nominating the following person for the Carter Catlett Williams Award for
Excellence in Aging or Long-term Care Services .

nominee*
nominee's organization*
nominee's address*
city*
state*
 zip code*
nominee's phone*

.Does the nominee know of the nomination?
.
my name*
my organization*
my phone*
my address*
city*
state* zip code*
my email*
.
.

Tell us how the nominee excels in his or her field. (The more examples you can give the better we'll be able to judge your nominee!)

Please tell us about the nominee’s professional background, or attach a current vitae.

Please tell us why you believe the nominee deserves to be recognized.

Thank you!

Please note that we will not accept nominations without completion of this form. You may submit other materials in addition to the form by mailing to Mary Rose McBride, Lifespan 1900 S Clinton Avenue, Roch, NY 14618.  Nominations are due no later than 5pm on Wednesday, March 4, 2009. Thank you.