Nomination Form You may submit up to two additional pages of supporting documents (ex:  newspaper clippings).   The Awards Committee will choose a final recipient based solely on the information you provide, so please note all the contributions and achievements, relevant to the award.  If you have questions or need clarification, please contact Tricia Gorden at 574-284-7108 or e-mail us at tgorden@realservices.org You may print the following form and mail it to the address below (please use this method if you wish to include additional pages of supporting documents) or you may submit the form on-line.

You must use the TAB key on your keyboard or your mouse
to go from field to field in the form below.
Pressing the Enter key will submit the form.

Nominee Information
Award Category:	Choose an Award Category Business of the year Caregiver of the Year for an Older Adult (60+) Caregiver of the Year for the Disabled (0-59) Education Award Hoosier Lifetime Award (over 60) Professional of the Year Kimble Volunteer of the Year Volunteer of the Year (under 60) Volunteer Group of the Year View Nomination Categories
Name:
Street Address:
City / State / Zip:
Phone Number:
The more information that you provide, the better the chance of winning! Here are some prompts to get you started: Describe specific activity(ies) this person has performed which benefited an older adult or a group of older adults or a disabled individual. Explain the impact these activities have had on you, other individuals or the community.
Please include any additional information which you feel is relevant to the award. (Examples include: recognitions/awards, attitude or life philosophy, commitment, how long they have been volunteering, the number of people who they have served, number of hours a month they give, etc.)
Your Information (Optional)
Name:
Street Address:
City / State / Zip:
Phone Number:
Email:

If you have questions or need clarification, please contact Tricia Gorden (574) 284-7108, or e-mail tgorden@realservices.org. Click here if you would like a printable version of the nomination form. 

If you choose to mail in a nomination, please address it to:

Age of Excellence Awards Committee
C/O Tricia Gorden
REAL Services / Area 2 Agency on Aging
P.O. Box 1835
South Bend, IN 46634-1835

e-mail us at aoe@realservices.org or call 800-552-7928, ext 7108