Awards for Excellence Nomination Form

Dr. Margaret L. Bauman made a pioneering discovery in autism research that continues to encourage individuals on the autism spectrum, and their families, caregivers, researchers, educators, therapists and professionals. Her Awards for Excellence are given in recognition of deserving, talented people who go above and beyond the call of duty in the autism field.

The Friends of Casa's Kids Committee will honor recipients of the Margaret L. Bauman, MD Awards for Excellence in the Autism Community at Wine and Cheese Awards Reception on Friday, April 5, 2013 at Casa Colina's Children's Services Center, located at 255 East Bonita Ave., Pomona CA, from 6:30 – 8:00 pm.

Join Us for FREE! An Adult ONLY event.

Please take a moment to nominate an outstanding individual in the community.
(All nomination are due by March 22, 2013).

Your Name:

Email:

Phone:

I would like to nominate this person to receive the Margaret L. Bauman, M.D., Awards for Excellence:

First Name: Last Name: Suffix:

Address


Street Address

City	State	Zip Code

Title: Company (if applicable):

Email:

Phone:

Please CHECK the Category of your Nomination: Teacher / Educator in School
Service Provider (Therapy or Early Intervention)
Parent or Professional in a Volunteer Role

Other:

I want to nominate this person because:

My name may be disclosed to the nominee YesNo, thank you.

I plan to attend the Awards Reception: (Friday, April 6, 2013 at the Casa Colina Children’s Center from 6:30 p.m. to 8:00 p.m.) YesNo, thank you. If yes, how many guests will you bring to the Awards Ceremony?