Earl and Mary Lohr Community Service Award — The Portage County Board of Developmental Disabilities

Earl and Mary Lohr Community Service Award

Want to recognize someone for providing exemplary advocacy, services, or supports that assist individuals with disabilities to live, work, learn, and socialize in our community—

Please take a moment to complete and return this nomination form.

A Selection Committee will consider nominations.

The recipient will be recognized at the March 2024 Board Meeting

Deadline for Nominations: Friday, February 23, 2024

Name of Nominee

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email

How has this nominee helped to fulfill the mission of the Board?

Describe any other achievements or information regarding this person or organization to support this nomination:

Nominated By

First Name

Last Name

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Phone

(###)

###

####

Email