VW Nomination Kit 2014.doc .pdf

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Annual Visionary Women Awards
Celebrating Caregivers

Join us in honoring dementia caregivers in Orange County. Explore the
scenic Rancho Las Lomas while enjoying a gourmet lunch, great
company, an artisan and gift boutique and a special featured guest
To celebrate exceptional individuals for their service to others, we invite nominations for our 2014 awards.
Honorees will be recognized at our 8th annual Visionary Women Luncheon on Friday May 9, 2014 at scenic
Rancho Las Lomas in Silverado Canyon.

Call for nominations for 2014 Caregiver Awards:
(1) Medical / Clinical Professional– physicians, researchers, geriatric counselors, clinical social workers, geriatric nurse
practitioners, care managers, case managers or other clinical professionals in the field of dementia care.
(2) Administrative professional - administrative professionals in licensed residential facilities, other care facilities, or
who serve as administrative professionals in other service agencies to persons with dementia (hospice, in home care etc).
(3) Professional Caregiver / Direct Service – paid caregivers who are on the frontlines of providing compassionate care
in the dementia field. This classification is appropriate for hospice workers, in-home care workers, RCFE employees, etc.
(4) Family Caregiver -- unpaid caregivers who are on the frontlines of providing compassionate care to a loved one with
Alzheimer’s or a related form of dementia (currently or in the past).
(5) Youth Caregiver – unpaid caregivers 18yrs and under who provide regular care for a loved one with dementia

To nominate a compassionate caregiver, please complete this submission form. All submissions are due
by Friday, April 4, 2014. Please contact Jessica at 949.757.3796 with inquiries about tickets, program ads or
event sponsorship.

Caregiver Awards Nomination Tool Kit
This is a powerful opportunity to honor outstanding dementia caregivers you may know or employ. It offers a valuable way
to elevate and acknowledge the excellence in your community or business.
Create a Caregiver Award at your place of business and submit your winner as a nominee to the Visionary
Women’s Luncheon*
• Honor your employees & encourage employees to nominate one another
• Invite your families to nominate superior caregivers for an internal award at your agency
• Honor your FAMILY Caregivers by making a nomination
The Alzheimer’s Association will provide:
• One ticket per business to the Visionary Women’s luncheon on Friday, May 9, 2014
• Nominations forms
• An award certificate for all nominees
• An Alzheimer’s Association Senior Staff person to assist in your on-site awards presentation
*We will gladly accept more than one nomination per site, but can only offer one complimentary seat per agency/business.

Orange County Chapter | 17771 Cowan, Suite 200, Irvine, CA 92614 | www.alz.org/oc | 24/7 Helpline: 800.272.3900

Visionary Women Caregiver Awards Submission Form
Name of Nominee: _________________________________________________________________
Mailing Address: ___________________________________________________________________
Phone: ______________________ Fax: ______________________ Email: ___________________
Occupation/Place of employment (if applicable): _________________________________________
Please indicate the applicable nomination category:
Medical / Clinical Professional
Administrative Professional
Youth Caregiver

Professional Caregiver / Direct Service
Family Caregiver

Description of your experience with the nominee:
On a separate piece of paper, explain why you think the nominee deserves to be honored.
(Entries MUST be at least 300 words, and CANNOT be more than 500 words to be considered)
Letters of recommendation:
Nominations are stronger with 1 – 3 letters of recommendation.
Your name (if not self-nominating):_____________________________________________________
Mailing Address: __________________________________________________________________
Phone: _____________________ Fax:___________________ Email: _______________________
Business/Profession (if applicable):____________________________________________________
Relationship to Nominee: ____________________________________________________________
Please send or e-mail a photo of the nominee:
By Mail: 17771 Cowan, Suite 200, Irvine, CA 92614


By E-mail: jessica.basile@alz.org

Please send completed submission forms to:
• Alzheimer’s Association, Awards Committee
17771 Cowan Suite 200, Irvine, CA 92614
• Or send by e-mail to jessica.basile@alz.org or fax to 949.333.6343
• You are welcome to self-nominate and/or make multiple submissions
Thank you for helping us to recognize the important work of caregivers throughout Orange County.
Please contact Jessica at 949.757.3769 with inquiries about tickets, program ads or event sponsorship.

Orange County Chapter | 17771 Cowan, Suite 200, Irvine, CA 92614 | www.alz.org/oc | 24/7 Helpline: 800.272.3900

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