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  • Susan Leiby
    Do you know of someone who has made an impact in the life of your family dealing with ASD? If so, please nominate them for one of these award categories and
    Message 1 of 1 , Sep 20, 2012
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      Do you know of someone who has made an impact in the life of your family dealing with ASD?  If so, please nominate them for one of these award categories and submit this form to SCAS at the address below, or by email or fax.  You can also visit our website at www.scautism.org and make your nomination online.  The people who are selected for these awards will be recognized at our annual conference on October 20, 2012.

      South Carolina Autism Society

      2012 Award Nomination Form


      Person making nomination:

      Your name____________________________________________________


      Address ______________________________________________________


      City / State / Zip ________________________________________________


      Telephone ______________________  Email ________________________


      Award Categories (check one):

      ___ Sibling Advocate

      ___ Teacher of the Year

      ___ Volunteer of the Year

      ___ Regional Consultant of the Year

      ___ Regional Director of the Year

      ___ Professional of the Year

      ___ Residential Staff Person of the Year 

      ___ Service Coordinator of the Year 

      ___ Employer of the Year

      ___ Employee of the Year

      ___ Presidential Citation

      ___ Other : Special Recognition  (You create the award)________________________



      Award Nominee’s Name ____________________________________________


      Address _________________________________________________________


      City/ State/ Zip ____________________________________________________


      Telephone _________________________  Email ________________________


      Is nominee a member of the South Carolina Autism Society ?  ______________




      If this nominee is chosen for the award how would you like them notified?

      ____ SCAS to contact            ____ Nominator will contact


      If chosen, SCAS invites the nominee and one guest to attend the luncheon at no cost.  Additional guests will be $15 each.  Please indicate the number of guests that would be attending if this nominee is chosen.  _____


      Please print or type on a separate sheet in 150 words or less why this nominee deserves special recognition.


      Nominations will not be accepted after October 5th, 2012


      Return completed form to:  SCAS, 652 806 12th Street, West Columbia, SC 29169 or email to scas@... or fax to 803-750-8121


      This form is also available on our website at www.scautism.org


      Delilah Bonnert
      SC Autism Society
      Information & Referral
      806 12th Street
      West Columbia, SC 29169


      Susan Leiby

      Special Events Coordinator, Strides for Autism
      Project Coordinator, "Guardianship & Protection"

      Project Coordinator, "All Are Welcome"

      South Carolina
      Autism Society

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