2025 Legislative Day Client Nomination Form

Please complete this form to nominate an agency CLIENT for a 2025 Community Action Award. Client nominees can include individuals, couples, families, groups, or organizations. However, please note that for group nominations, only one $100 gift card will be awarded to the selected nominee.*

Please complete and submit your nomination form by March 21, 2025. The awards will be distributed at our Michigan Community Action Legislative Day at the State Capitol in Heritage Hall in downtown Lansing on May 21, 2025, for Community Action Month.

A list of guidelines to consider when choosing your nominees. MCA Client/Volunteer Nomination Criteria

Fields marked with an * are required.

Name of Nominee *

City/Township of Nominee's Residence *

Has this nomination been approved by your CAA's Executive Director? *

Nominations must be approved by the ED

Yes

Nominated By

First Name *

Last Name *

CAA Name *

Client Nomination Narrative

Give a brief narrative history of the circumstances that brought the Client to seek CAA services. *

Describe what services were accessed by the Client to overcome barriers to self-sufficiency. *

Describe the Clients achievements and successes due to the CAA services he/she received. *

Any additional information you would like to share about your nominee

Please verify that you have checked the “I'm not a robot” checkbox.