Medford Commission for Persons with Disabilities
“2008 Disability Awareness Awards”
The Medford Commission for Persons with Disabilities is sponsoring the “2008 Disability Awareness Awards”. This award program is to recognize individuals, agencies, and/or businesses in Medford that consistently strive for equality and independence for people with disabilities. The support provided could include accessibility to employment, public accommodations, housing, etc. (for more info call: 393-2501)
Please print, complete this nomination form and return it to: Diversity Office, City Hall, Room 214, City Hall, Medford, MA 02155 no later than May 18, 2008.
Nomination
Name: ___________________________________________
Address: _________________________________________
City/State: _____________________________ ZIP: _______
Telephone: _______________________________
Reason for nomination: ___________________________________________________
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(attach additional forms if needed and any corroborating information)
Nominated by:
Name: ___________________________________________
Address: _________________________________________
City/State: _____________________________ ZIP: _______
Telephone: _______________________________
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