Dandurand Award Nomination Form

The Matthew Dandurand Award for Exceptional Effort

This award is sponsored by the Matthew Dandurand Memorial Fund, and is intended to honor a teen or young adult (ages 13-22) with a diagnosis of AS (or a similar social-communication deficit, including NLD, PDD-NOS, or HFA) who lives in Central or Western Massachusetts. An individual must meet all three criteria to be considered.

You can also download the nomination form here and mail to the following address:

AANE
51 Water St. Suite 206
Watertown, MA 02472

You can also send the form by fax to (617) 393-3827.

All nominations must be received by May 11, 2012.

 

Nominator Contact Information:

Name
Phone
Email
Address
City
State
Zip Code

 

Nominee Contact Information:

Name
Phone
Address
City
State
Zip Code
Date of Birth / Age

 

Please answer the following about the nominee:

In what capacity and for how long have you worked or been involved with this person?
What has this individual done to merit your nomination? Please describe (in as much detail as possible) why you nominated this teen or young adult.