Lifetime Achievement Nomination Form 2019 C2C Lifetime Achievement Nomination The Lifetime Achievement award honors a single individual nearing the end of their career or retired for his or her lifetime contribution to enriching the lives of individuals with disabilities. The recipient of this award embraces the values of inclusion, collaboration and advocacy. Your Name* First Last Your Phone Number*Your Email Address* Nominee Name* First Last If you are nominating an organization, skip this and go to organization.Nominee's Title/PositionNominee Address* Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Nominee Phone Number*Nominee Email* Nominee PhotoPlease upload a picture of the nominee if you have one.Please share specific examples of how the nominee's accomplishments throughout his or her lifetime created opportunities for individuals with disabilities.*250 words maximumPlease share specific examples of how the lives of individuals with disabilities improved because of the nominee's work?*Please share specific examples of how the nominee inspired others to get involved, take responsibility, or assume leadership positions.*If you have any further information you would like to share about the nominee please write it down here.150 words maximumNameThis field is for validation purposes and should be left unchanged.