IN-APSE Professional Award

2011Annual Award Nomination Form

SUBMITTED BY:

APSE Membership must be current. (Please print):

Name of person making the nomination

Mailing addressCity, State, Zip

Area code and daytime phone APSE Membership Number Relationship to nominee

NOMINEE:

Name of NomineeArea code and daytime phone

TitleCompany

Mailing AddressCity, State, Zip

Email Address

DEADLINE

Complete this form and submit with supporting statements by mail no later than October 15th 2011 to:

Ron RoembkeEmail:

Easter Seals CrossroadsPhone: (317) 466-1000 ext. 2434

4740 Kingsway DriveFax: (317) 466-2000

Indianapolis, IN46205

PURPOSE

To confer recognition for outstanding professional achievements as a job coach, job developer, employment specialist or state agency personnel.

ELIGIBILITY

This award is designed to reward highly effective professionals who demonstrate trustworthiness, respectfulness, supportiveness and innovation in their interactions with supported employees, as well as with their friends, family members and employers.

CRITERIA

The following criteria serve as a guide in evaluating the nominee. A nomination for this award should include descriptions of how the nominee meets any of the criteria in each of the four areas as it applies to their support roles. Nominations should be corroborated with letters from others who have knowledge of the nominee’s work, i.e., person with a disability, family member, business person, nominee’s supervisor or coworkers, etc.

Trustworthiness

  • Professional does what she/he says she or he will.
  • The person with a disability and family are comfortable sharing sensitive personal or private information with the Professional.
  • Professional puts the person with a disability’s needs ahead of his/her own or those of the agency.
  • Professional is responsive to employer’s concern while upholding the integrity of the employer-employee relationship.
  • Professional enables the person with a disability to make choices based on his or her preferences even if they are different from the Professional’s wishes.

Respectfulness

  • Professional presents the person with a disability in an image-enhancing and positive way.
  • Professional protects the person with a disability’s right to privacy and confidentiality.
  • Professional assists the person with a disability in accessing activities of their choice.
  • Professional facilitates the development of mutually satisfying social relationships between the person and others.
  • Professional’s behavior toward the person with a disability demonstrates the person’s status as a valued and equal individual.

Supportiveness

  • Professional individualizes type, frequency and duration of support to person with a disability based on the person’s preferences and needs.
  • Professional demonstrates flexibility in terms of work schedule and availability to the person with a disability, family and employer.
  • Professional is responsive to the concerns of family members or others who are involved with the person with a disability.
  • Professional is a resource for information or services regarding things such as Social Security Work Incentives, housing options, community activities, educational or training opportunities, etc.
  • Professional is willing to support any individual with a desire to work regardless of the perceived severity of the disability or perceived behavioral or emotional challenges.

Innovation

  • Professional demonstrates creativity in assisting the person with a disability in designing supports and accommodations needed rather than being restricted by perceived system limitations.
  • Professional assists the person with a disability in accessing community resources and activities that match the person with a disability’s interests.
  • Professional assists the employer, when appropriate, in job carving, sensitivity training, accessing or developing assistive technology.
  • Professional supplements, when necessary, rather than supplants, the training and support available on the job site and in the community.

NOTE: When answering these questions, please include as many specific examples as possible to help “tell the story” of why this nominee deserves to win this award. Please use a separate sheet of paper if necessary.

EVALUATION

Please answer the following questions using the award criteria as a guide and attach any corroborating letters (use additional paper as needed). Please type submissions.

  1. In what ways does the nominee demonstrate trustworthiness?

______

  1. In what ways does the nominee demonstrate respectfulness?

______

  1. In what ways does the nominee demonstrate supportiveness?

______

  1. In what ways does the nominee demonstrate innovation?

______

All nominations must include one letter of support from at least two of the following individuals (Please attach to this form): Supervisor, coworker and/or person nominating professional

THANK YOU!