THE ANNE ARUNDEL COUNTY COMMISSION ON DISABILITY ISSUES ANNUAL AWARD NOMINATION FORM

PLEASE PRINT
Name of person submitting this nomination
Area code & phone number



Mailing address
City
  State
Zip code





Name of Nominee
Area code & phone number



Mailing address
City
  State
Zip code






SIZE OF BUSSINESS: (  )Small (less than 16 employees)
          (  )Medium (16 to 100)        (  )Large (over 100 employees)

DEADLINE:                 AUGUST 13,  2004

There are three categories in which awards can be earned:
1. Employer of the year
2. Businesses that Remove all Barriers
3. Disability Friendly  (Buildings in the Historic District are
held to strict guidelines for external and some internal
renovations.  This award is for doing the maximum changes
under these restrictions.  Also, the staff has to be willing to
“go the extra mile” for accommodating the [shopper] PATRON.)

Employer of the year
1. What is your reason for the nomination?  Were legal require-
ments exceeded?   ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Has an effort been made (special orientation or training) to accommodate workers’ disabilities?  Please explain.    __________________________________________________________________________________________________________________________________________________________________
____________________________________________________________________________________________________________


Businesses that Remove all Barriers and Disability Friendly
1. Has there been an effort (facility alteration; such as railings ect.) to accommodate employees or customers with disabilities?  Please explain.     ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
2. Are the management and employees willing to “go the extra 
mile” (exceed ADA guidelines: take merchandise to the door, set up a web sight for shopping at home, etc.) to accommodate a customer with disabilities?  Please describe. 
____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Multiple winners are possible.

If there are any questions, please call the ADA Office:
	Voice 410-222-4383
	TTD/TTY 410-222-4355
	FAX 410-222-4360
	agande23@aacounty.org 

* Self-nominations are welcome.
* If more space is needed, attach another piece of paper