LIFE Star Award Nomination

Please complete this short form to acknowledge LIFE individuals, staff, family members, or others in the LIFE community with a LIFE Star Award.

This could be an initiative that made a difference, regardless of the size or effort it took, from an act of kindness to last-minute staff coverage. The LIFE community has many shining stars, and we invite you to shine a spotlight on these super stars.

Let them know you appreciate their noteworthy action.

Your Information:

Your Name: *

First Name

Last Name

What LIFE program(s) are you affiliated with?

Please check all that apply.

SIL

Individual Supports

Group Homes

Shared Living

CBDS

Employment

Administration

Email *

Verify Email *

What is your LIFE affiliation?

Please check all that apply.

LIFE Individual

Staff

Parent

Family Member

LIFE Star Nominee

Please include information about the LIFE individual, employee, or group you are nominating for a Star Award.

Are you nominating an individual or a group? *

Individual

Group

Who are you nominating? *

Please include individual(s) or group you wish to nominate.

NOMINEE: What is the nominee's affiliation with LIFE?

LIFE Individual

LIFE Employee

LIFE Family Member

NOMINEE: With which LIFE program(s) is the nominee affiliated?

Please check all that apply.

SIL

Shared Living

Group Homes

Individual Supports

CBDS

Employment

Administration

Please describe the action you would like to recognize? *

Anything else you want to share?

OPTIONAL: Would you like to make a donation in honor of your nominee?

Gifts made in honor of individuals is a special way to show appreciation. The individual or group who is named in such a gift is notified that a gift has been made in their honor, including any message provided along with the donation.

This is totally OPTIONAL. All nominations will be recognized regardless of whether you choose to make a donation or not. This is simply an additional way to show appreciation while supporting the important programs and services at LIFE.

***PLEASE NOTE*** Gifts through this form are made to Living Independently Forever, Inc.® in honor of the named individual, and can be designated for a general program or category (but cannot be paid directly to an individual). Notification will be sent of the submission to the honored individual and their leadership team to ensure appropriate recognition for their impact.

If you prefer to give a personal gift directly to your nominated staff member, you are welcome to do so as long as it does not exceed $500 per year. To avoid any potential conflicts of interest, we do ask that both staff and family disclose any direct gifts to Living Independently Forever, Inc.®

Any questions can be directed to LIFE's Development Director at development@lifecapecod.org

Would you like to make an OPTIONAL donation today in honor of your nominee?

Yes

Amount:

$100

$50

$25

$10

Donation Schedule

Additional information for this gift:

Include any notes to share with the gift to the nominee(s), as well as any other information you would like LIFE to know about this gift.