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2017 Justice Center Code of Conduct Recognition Award:
Dedication, Respect and Protection from Harm

Nomination Form

Required Information
Submitting Your Nomination
 
Please complete the following information and submit by Friday, July 14, 2017.
Nominee Information
Tell us about yourself.

Examples for the "Relationship with Nominee" field include: Service Recipient, Family Member, Supervisor, Other 
Please provide general information about the individual you are nominating for this award.  For example, years of service, assistance provided and notable achievements.

Nomination Narratives
Help us get to know the nominee.  Use the sections below to describe how the individual has positively impacted the lives of people receiving services. Please provide as many specific examples as possible.
Does the individual demonstrate a person-centered approach?
 
 
Does the individual take into consideration the physical, emotional and personal well-being of people receiving services?
 
 
Does the individual take into consideration the importance of respect, dignity and choice for people receiving services?
 
 
Does the individual support self-determination for people receiving services?
 
 
Does the individual advocate with/for people receiving services?
 
 
Does the individual respect the personal health information and confidentiality of people receiving services?
 
 
Does the individual demonstrate integrity, responsibility and professional competency?
 
 
Does the individual uphold reporting requirements as a mandated reporter?