Champions for Change Award Nomination Form

Fields marked with an * are required.

Nominator Name *

What is your name?

Nominator Email *

What is your email?

Nominee Name *

Please list the name of the person you are nominating

Does the Agency employ an IPRA Member? *

Did this take place in 2022 or 2023? *

DEI Overview *

In 750 words or less, explain the services, training, and/or programs supporting DEI for employees and/or the community and its purpose, including statement of need, its history, goals, and development.In 750 words or less, explain the services, training, and/or programs supporting DEI for employees and/or the community and its purpose, including statement of need, its history, goals, and development.

DEI Impact *

In 750 words or less, describe the overall impact of the work to the organization or community, including measurable short/long-term outcomes.

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