Name of Nominee *

City/Township of Nominee's Residence *

Has this nomination been approved by your CAA's Executive Director? *

Nominations must be approved by the ED

Yes

No

Client video/ testimonial

Is the client comfortable and willing to be recorded for a video to share at the 2026 MCA Legislative Day in Lansing?

Please note the client is NOT required to record a video unless they want to.

Yes No

First Name *

Last Name *

CAA Name *

Email

Give a brief narrative history of the circumstances that brought the Client to seek CAA services. *

Describe what services were accessed by the Client to overcome barriers to self-sufficiency. *

Clients achievements, milestones, and measurable outcomes. *

Describe the client’s achievements, milestones, or measurable outcomes that resulted from the CAA services received.

Please explain how these services contributed to increased stability, independence, or progress toward self-sufficiency.

Additional information you would like to share about your nominee.

Please share any additional information that helps illustrate the client’s journey, resilience, or growth, or the broader impact of your agency’s support.

This may include a personal anecdote, quote, or insight that brings the client’s story to life.