2010 Paula Bailey “Inspirational Community Member” Award Nomination Form

The Lighthouse of the Big Bend invites you to nominate someone you find inspirational for this award! The award is presented by the Lighthouse at the Paula Bailey Dining in the Dark event (10/24/10) to an inspirational member of the community. Inspirational is defined as: the ability to invoke positive emotion and action in others. Nomination forms must be received in the Lighthouse office by September 15, 2010.

Qualifications
To qualify for the award, each individual must be:
1. Visually impaired or blind (from birth or later in life)
2. A resident of one of the 11 counties the Lighthouse of the Big Bend serves: Franklin, Gadsden, Hamilton, Jefferson, Lafayette, Leon, Liberty, Madison, Suwannee, Taylor or Wakulla
3. An individual who has not won the award in the past 10 years

About you (the nominator):
Nominator’s Name: ____________________________________________________________
Nominator’s Street Address: _____________________________________________________
Nominator’s City: ______________________________ State:___________ Zipcode: ________
Nominator’s Phone: ____________________________________________________________
Nominator’s Email: ____________________________________________________________

About the person you would like honored (hereafter called the “honoree”):
Honoree’s Name: _____________________________________________________________
Honoree’s Street Address: ______________________________________________________
Honoree’s City: _______________________________ State:___________ Zipcode: ________
Honoree’s Phone: _____________________________________________________________
Honoree’s Email: ______________________________________________________________

On a separate document, please provide a description of the following in a typed format:
1. When and how the honoree became visually impaired or blind;
2. How the honoree has coped with her or his vision loss to maintain or regain his or her independence; and
3. How the honoree has been an inspiration to her or his community and invoked positive emotion and action in others.
Supplemental materials are not required but may include a current resume and information from the past two calendar years such as published articles or letters of recommendation.

Submission
Please submit your nomination form by September 15, 2010 to Barbara Ross, Lighthouse Executive Director, in one of the following formats (email is the preferred format):
Email: info@lighthousebigbend.org, Fax: 850-942-4518, or
Mail: Lighthouse of the Big Bend, 3071 Highland Oaks Terrace, Tallahassee, FL, 32301.

Award criteria and procedure
A three-member Lighthouse of the Big Bend Board selection committee will rank each honoree on a scale of 1-10 as to how inspirational they have been to the community in terms of coping with their vision loss (10 points), regaining or maintaining their independence (10 points), and invoking positive emotion and actions in others (10 points). Each selection committee member score will be added together and the honoree with the highest score will win the award. None of the three member selection committee may be nominated for the award.

A word document of the form is available here: Paula Bailey Inspirational Community Member Award

Updated 5/18/10