2013 Child Advocate Awards

NOMINATION FORM

Complete & Return by February 8, 2013

The Michigan Fatherhood Coalition Awards Program is seeking nominees for the following four following categories:

1. Outstanding Father/Positive Male Role Model: In this category the nominee will be chosen based on their positive male parenting through trying circumstances along with their ability to provide strong role modeling to peers. Please tell us this person’s story and how they advocate for child well-being.

2. Outstanding Children’s Services Professional/Practitioner: In this category the nominee is recognized by others as a person that goes above and beyond the call of duty to advocate for children/families in a professional manner.

3. Outstanding Non-Profit Human Service Delivery Agency/Organization: In this category the nominee demonstrates that they advocate for children and families throughout the year.

4. Outstanding Individual/Organization/Business: In this category the nominee is recognized for the support given to MFC by giving of their time, space or funding to help MFC meet its mission statement of positive outcomes for children through responsible fatherhood and nurturing parenting.

Individuals who submit the MFC selected award winner will receive one Registration Refund (valued at $45.00) for attendance to the 2013 MFC Michigan Fatherhood Conference on February 22, 2013 at

214 Brooks Street, Howell, MI 48845

How to Nominate: A separate form is to be completed for each nominee and there are no limits in the number of nominations an individual can submit. If you know of a person, organization / business that you would like to be recognized for their dedication, please complete the following page. Include reasons for your nomination and provide AS MUCH INFORMATION as possible, so that an informed decision can be made.

Name of nominated person/organization: ______

Mailing address ______

Daytime phone ______Evening phone ______

E-mail ______

Nominated by: ______

Mailing address ______

Daytime phone ______Evening phone ______

E-mail ______

-Please describe the nominee’s advocacy work for children, fathers and families in your community. Cite examples of this person or organization’s leadership on behalf of children, fathers and families. (feel free to attach a response on a separate page)

-What has been achieved because of this person or organizations work that enhances the well-being of children through positive father engagement in your community. (feel free to attach a response on a separate page)

Please include the name/contact info of an another person who can support the nomination:

Name ______Mailing address ______

Daytime phone______Evening phone ______

E-mail ______

RETURN this form to Mike Kildee…

E-mail:

FAX: 810-591-3650

Questions: 810-591-7232

Complete and Return by February 8, 2013

DISCLAIMER:

The Michigan Fatherhood Coalition (MFC) is a Responsible Fatherhood Organization, whose primary focus is on improving child outcomes through positive male parenting. These MFC awards are child focused and are intended to promote Michigan child well being. MFC wishes to celebrate the efforts of individuals and agencies who exemplify and embrace this concept through our awards program. Individuals, agencies ororganizations that are Father’s Rights and Father Leadership movement based are not appropriate for nomination.

Michigan Fatherhood Coalition

Nomination Form