Family Services Leadership Award Nominations 2023

The ACPA Family Services Leadership Award recognizes an individual or group that has demonstrated exceptional community service and leadership on behalf of individuals with cleft or craniofacial differences.

After nomination and review of his or her qualifications by the Honors and Awards Selection Panel, a candidate may be granted the Family Services Leadership Award by a two-thirds majority approval of the Board of Directors.

Award nominations must be made by a sponsor and co-sponsor who provide cleft-related services. Cleft and craniofacial care providers are not eligible for this award.

The deadline to submit nominations is October 5, 2022. Please contact erin.brenneman@acpa-cpf.org for questions.

1. Enter your personal information.

First Name *This question is required.

Last Name *This question is required.

Email Address *This question is required. This question requires a valid email address.

Phone Number

Institution

Street Address *This question is required.

Apt/Suite/Office

City *This question is required.

State/Province

Zip/Postal Code

Country *This question is required.

2. Please enter the name and contact information of the candidate being nominated.

Name or Group Name *This question is required.

Email Address

Phone Number

Institution

Street Address

Apt/Suite/Office

City

State

Zip

Country

3. Please indicate the areas in which the candidate has served the cleft-craniofacial community. *This question is required.

Advocacy
Education
Legislative Activity
Public Awareness
Service
Support/Community Building
Other - Write In (Required) Please enter an 'other' value for this selection. * This question is required.

4. Please detail evidence of the candidate's service and leadership to the cleft-craniofacial community. *This question is required.

5. Upload a letter of support. This letter should provide details of the candidate’s accomplishments and contributions that are deemed worthy of the ACPA Family Services Leadership Award using the following criteria:

Response to Need
Delivery of Service
Dedication to Leadership/Service

*This question is required.

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