MDSC Employer Award Nomination Form

Your Information:

First Name Last Name

Street Address

City State Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code

Email Address Phone Number

Nominee's Information:

First Name Last Name

Street Address

City State Select State Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virgin Islands Virginia Washington West Virginia Wisconsin Wyoming Zip Code

Email Address Phone Number

Name of Business

Nominating letters should include specific examples rather than general statements about the person or company.  Please submit a letter of nomination, not to exceed two pages, answering the following questions:   

• What is the employer's record of hiring people with Down syndrome and/or other disabilities?
• Give an example of at least one employee with disabilities for works for the employer.
• How has the employer help create an inclusive work environment?
• How has the hiring of people with disabilities been good for the employer, employee, co-workers and/or customers?
• How has the employer been proactive in developing and promoting inclusive employment practices for other employers to emulate?

Attach Nomination Letter

= Required

Nominations may also be sent by mail to: MDSC Nominations, 20 Burlington Mall Road, Suite 261, Burlington, MA 01803. Nominations by mail should be postmarked no later than February 1.  Click here to download Exemplary Employer Award Nomination Form.