Braille Monitor                                                    January 2008

(back) (contents) (next)

 

Award Application Form
2008 Dr. Jacob Bolotin Awards

Sponsored by the Alfred & Rosalind Perlman Trust
Presented by the National Federation of the Blind (NFB)


Applicants must have demonstrated substantial initiative and leadership in improving the lives of the blind. An application for an award may be made either by the applicant directly or by third parties who nominate an applicant.

1. AWARD CATEGORY (choose one)
___ Blind applicant ___ Sighted applicant ___ Organization or group

2. PERSON COMPLETING THIS FORM (choose one)
___ I am applying for an award for myself.
___ I am a representative of an organization which I am nominating for an award.
___ I am a third party nominating an individual or an organization for an award.

3. CONTACT INFORMATION

3(a) For the individual or organization being nominated:
Name of the individual or organization being nominated:


The individualís or organizationís address, daytime telephone numbers, email address, and Website address:


3(b) For organizations only:
Provide the name of the contact person for the organization, his/her title, daytime telephone number, and email address:

3(c) For a representative of an organization or a third party making a nomination for an individual or an organization:
State your name, title, address, daytime telephone numbers and best time to call, and email address


What is your relationship to the applicant?

4. THE ESSAY
The Dr. Jacob Bolotin Award recognizes individuals and organizations working in the field of blindness that have made outstanding contributions toward achieving the full integration of the blind into society on the basis of equality. In 800 words or less, please answer the questions below about the project, service, or other endeavor of the individual or organization nominated that benefited blind Americans in the past year. Please attach the essay to this application.
4(a) State the name and describe the project.
4(b) What is the individualís or organizationís role in the project?
4(c) Who benefited from the project?
Without breaking confidentiality, who has benefited, where do they live in the United States, and approximately how many people have benefited?
4(d) What is the timeframe of the project? Give a beginning date, and, if the project has ended, give an ending date.
4(e) What effect has the project had on blind people? Does the project pioneer new ideas or initiatives for the blind?
4(f) Additional information. List other information that the Committee should consider in determining the merits of the nominee.

 

5. LETTER OF RECOMMENDATION
Each application must include at least one letter of recommendation from a person familiar with or directly affected by the work done by the nominee. For each letter of recommendation included with the application, list the personís name and state, as well as each personís relationship to the nominee and to the project. Letters of recommendation may be mailed directly to the chairman of the Dr. Jacob Bolotin Award Committee at the address listed below.

6. CERTIFICATION STATEMENT
I certify that the information provided in this application is true and accurate to the best of my knowledge. I understand that excerpts from this application may be used by the National Federation of the Blind for public purposes. The nominee or person accepting the award on behalf of a nominated organization is at least eighteen years of age at the time of application, is domiciled in the United States of America, and, if chosen to receive a Dr. Jacob Bolotin Award, will attend the 2008 National Federation of the Blind National Convention in Dallas, Texas, to accept the award. The work of the nominee (either individual or organization) has primarily benefited blind people within the United States of America.

Signature: ____________________________________________________

Printed name: _________________________________________________

Date: ________________________________________________________


The completed application should be mailed to:

Gary Wunder, Chairman
Dr. Jacob Bolotin Award Committee
National Federation of the Blind
1800 Johnson Street
Baltimore, Maryland 21230

(back) (contents) (next)