Legacy Leader Nomination

Please complete the form below to submit your nomination for 2024 induction into the Legacy Leader Hall of Fame. Submissions are due by Friday, January 10, 2025.

If you have questions about the nomination process, please email Sasha Sencer.

Legacy Leader Hall of Fame

Revised in 2024, the Legacy Leader Hall of Fame serves to recognize retiring or recently retired longtime ANCOR members who have positively influenced the shape of our association.

Nominator Information

Name(Required)

First Last

Pronouns

Organization(Required)

Job Title(Required)

Email(Required)

Phone (Work)(Required)

Numbers only. No parentheses or dashes.

Phone (Mobile)

Numbers only. No parentheses or dashes.

Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code

Relationship to Nominee(Required)

Nominee Information

Name(Required)

First Last

Pronouns

Organization(Required)

Job Title(Required)

Email(Required)

Phone (Work)(Required)

Numbers only. No parentheses or dashes.

Phone (Mobile)

Numbers only. No parentheses or dashes.

Address(Required)

Street Address Address Line 2 City State ZIP / Postal Code

Years of service in the field of IDD(Required)

20+ years is required, if not yet applicable, please use the nomination form for the Mid Career Rising Star award

Please share how the Nominee has shaped ANCOR into a stronger association. Identify and describe at minimum three ways the nominee’s time and/or talents have resulted in a positive legacy for ANCOR and its members. We encourage you to consider the ripple effects the nominee’s actions have had on individuals, organizations, and the community at-large.(Required)

(500 maximum word length)

Posthumous Nominee

Yes

Check here if distinction is being submitted posthumously.

Nominee Photo

Accepted file types: jpg, png, Max. file size: 5 MB.

For publicity purposes, submit a digital photograph (headshot) of the nominee. PNG or JPG only. Max file size 5 MB. If you are experiencing issues attaching a photograph to this form, then send it via email to [email protected].

Letters of Recommendation(Required)

Drop files here or

Accepted file types: doc, docx, pdf, Max. file size: 5 MB.

Please attach the additional two recommendation letters in support of this nomination. If you are experiencing issues attaching a file to this form, then send it via email to [email protected].

Nominee Engagement(Required)

The nominee DOES know that they are being nominated.

The nominee DOES NOT know that they are being nominated.

Submission

Electronic Signature(Required)

First Name Last Name

Date(Required)