ANCOR DSP NOMINATION FORM

TIME TO NOMINATE A DSP FOR ANCOR'S DSP OF THE YEAR AWARD!

Every year, ANCOR accepts DSP nominations from agencies across the country. They select one DSP from each state who goes above any beyond the requirements of their job description. ANCOR then shares the winning stories with Congress to advocate for DSPs.

Fill out the form below to nominate a DSP who goes above and beyond!

ANCOR DSP of the year nomination form

* Indicates required field

Nominee: *

Program/Site: *

Supervisor's Name: *

Your Name/EEDA Email Address: *

Is this nominee willing to be nominated, and if they win, travel to the award ceremony in Portland, Oregon (paid for by EEDA)? *

How does the nominee promote person-centered plans to support the individuals they work with? *

How does the nominee help the individuals they support create and maintain friendships and relationships outside of staff? *

How has the nominee demonstrated teamwork and leadership? *

How does the nominee "think outside the box" to improve the quality of life for the people they support? *

Tell us why the nominee is an excellent DSP: *

Feel free to tell us any additional information or accomplishments that qualify the nominee for this award: *

Submit

East End Disability Associates, Inc.
107 Roanoke Avenue
Riverhead, NY 11901
(631) 369-7345
info@eed-a.org