2024 Legislative Day Client Nomination Form

Please complete this form to nominate an agency CLIENT for a 2024 Community Action Award. Client nominees may be individuals, couples and families, groups, or organizations, however, in the case of a group award, only one $100 gift card will be given to the selected nominee.*

Please complete and submit your nomination form by March 22, 2024. The awards will be distributed at our Michigan Community Action Legislative Day at the State Capitol in the new Heritage Hall in downtown Lansing on May 22, 2024, for Community Action Month. All nominees who are selected by the awards committee will be called forward to receive awards.

*In the case of a collective award, as for an organization, MCA can provide certificates for individual members of the organization, but only one gift card will be awarded.

A list of guidelines to consider when choosing your nominees. MCA Client/Volunteer Nomination Criteria

Fields marked with an * are required.

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

Nominated By

First Name *

Last Name *

CAA Name *

Client Nomination Narrative

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. *

Describe the Clients achievements and successes due to the CAA services he/she received. *

Any additional information you would like to share about your nominee

Please verify that you have checked the “I'm not a robot” checkbox.