NCCAA Hall of Fame Award Nomination Form

Inductees for the 2025 Hall of Fame will join an esteemed list of champions, including change agents in our local communities, passionate members of various Boards of Directors, Executive Directors, volunteers, and awesome members of your staff. Nominations must be submitted by Friday, March 21, 2025.


Nominee Information - In the section below please provide the name and contact information of the Hall of Fame nominee. If the nominee is deceased, please provide contact information (address and phone number) for the family member or representative who will accept the award on their behalf.

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* 1. Nominee Full Name

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* 2. Nominee (or representative) Address

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* 3. Nominee's Occupation

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* 4. Nominee's Birth Date

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* 5. Nominee is:

Hall of Fame Nominee Categories:

  • CHAMPION An individual outside of the community action network who has made an impact and contribution to the community action movement.
  • BOARD OF DIRECTORS A board member whose leadership and community involvement are recognized within the community the agency serves.
  • EXECUTIVE DIRECTORS An executive director whose dedication, guidance, work ethic, and loyalty to community action have brought about a change in the agency and the community served.
  • STAFF A staff person whose good work ethic, loyalty, longevity, and dedication have delivered a positive change in the agency and community.

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* 6. Nominee is qualified for nomination in the following category: (If the nominee qualifies in more than one category, select the one you consider the most appropriate.)

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* 7. What accomplishments qualify this nominee for induction into the NCCAA Hall of Fame? (Please limit description of qualifications to two hundred words or less. If you have newspaper clippings or other supporting information, you may send scanned copies to krystina.dillard@nccaa.net.) **Visit the NCCAA Hall of Fame webpage for past inductee write-ups - NCCAA Hall of Fame

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* 8. Please provide a brief biographical sketch of the nominee:

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* 9. Photo & Video Requirement: 1 headshot photograph, 3 – 5 photographs of the inductee working in the community, and a two- to three-minute video of an interview with the nominee or someone speaking about the significance of his/her accomplishments. These digital items must be submitted via email to krystina.dillard@nccaa.net within 1 week of the Hall of Fame nomination submission.

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* 10. Nomination applications must be accompanied by a $150 non-refundable nomination fee for each application submitted for consideration into the NCCAA Hall of Fame. Please indicate below if you have already submitted payment or if you will submit payment after this submission. To submit your payment please click or copy/paste the link below into your browser to visit the payment page: 2025 Hall of Fame Nominations Payment

Nominator Information - In the section below please provide the name and contact information of the person and agency submitting this nomination.

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* 11. Nominator Information & Agency Address

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* 12. Nominator Title

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