2024 Department for Aging and Independent Living Annual Senior Hunger Summit

Senior Hunger Champion Award Nomination Form

The Department is seeking nominations for a Corporate, Local, and Legislative, Senior Hunger Champion. These awards will be presented at the upcoming virtual Kentucky Senior Hunger Summit on November 6th, 2024. Please complete the nomination form below and submit no later than COB September 30th, 2024, for consideration. If you wish to make more than one nomination you must submit a separate form for each. Thank you.

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* 1. Nomination Type:

Corporate Senior Hunger Champion (Kentucky corporation or local/regional business entity)

Local Senior Hunger Champion (Kentucky agency or other organization, individual citizen or group of citizens)

Legislative Senior Hunger Champion (Kentucky legislator that has made an impact on senior hunger)

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* 2. Please provide Nominee Information:

Nominee's Name

Title/Occupation

Company/Organization

Work Address

City/Town

State/Province

ZIP/Postal Code

Phone Number

Complete each section below and briefly describe how the nominee meets the LEAD Senior Hunger Champion criteria.

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* 3. Leadership – Describe the nominee’s leadership qualities and specific impacts and contributions to end senior hunger.

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* 4. Equity – Describe actions taken to remove barriers and/or demonstrate equity in services or resources aimed at addressing senior hunger.

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* 5. Accessibility – Describe actions taken that promote accessibility of seniors with disabilities to healthy food and nutrition.

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* 6. Diversity – Describe actions taken that embrace inclusiveness and a multi-cultural approach to hunger initiatives, community outreach, and services rendered.

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* 7. List other reasons this entity or individual merits this award.

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* 8. Please provide your contact information:

Nominating Person

City

State

ZIP Code

Email Address

Phone Number