New York Federation of the Council for Exceptional Children Yes I Can!

*** AWARD NOMINATIONS ACCEPTED THROUGH 10/10/14
New York Federation of the
Council for Exceptional Children
Yes I Can! Awards
2014 Nomination Application
The New York Federation for the Council for Exceptional Children, along with the International
Council for Exceptional Children, is a community of
professionals who are the voice and vision of special
and gifted education. Our missions are to improve,
through excellence and advocacy, the education and
quality of life for children and youth with exceptionalities and to enhance the engagement of their families.
The Yes I Can! Awards honor students with disabilities who excel. These awards celebrate the achievements of children, youth, and adolescence with disabilities; encourage these individuals to seek their
highest potential; and increase public awareness of
the abilities, aspirations, and personal qualities of
those with disabilities. Each candidate must be nominated by one individual (e.g., teacher, principal,
related service provider, friend, parent). The nominator does not need to be a CEC member.
The Yes I Can! Awards Review Committee will select a winner in one of the following categories:
• Academics
• Arts
• Athletics
• School and Community Activities
• Self-Advocacy
• Technology
• Transition
Award Benefits
The Yes I Can! Award winner will:
• be invited to attend a special awards ceremony
and celebration at the NYSCEC Conference to
be held 11/1/2014;
• receive one-night accommodations at the
NYSCEC Annual Conference on 10/31/2014 if
they are traveling more than 100 miles to the location of the conference, Syracuse, NY, where
the awards ceremony will be held;
• receive an award plaque with inscription;
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have the nomination forwarded to National
CEC for the National Yes I Can! Awards; and
be featured on the NYSCEC Website and journal.
Each individual nominated for a Yes I Can! Award
will receive a Certificate of Accomplishment. Certificates are sent to the nominator, not the nominee.
Braille and large-print certificates are available (see
Section B of the nomination form).
Eligibility Requirements
Candidates must be 5–21 years of age when they
are nominated. The nominee must have an identified disability. Each candidate may be nominated in
only one category.
Award Selection Considerations
The Selection Committee looks at not only the student’s achievements but also the severity of the
student’s disability in relation to his or her
achievements. In the event of a tie, additional
weight will be given to the nominee from a CEC
member or unit.
Rules and Instructions for Nomination
Each candidate may be nominated in one category
only. Nominations must be submitted in hard copy.
All materials submitted become the property of
CEC and will not be returned. All nomination materials (including supporting documentation) must
be submitted together.
How to Complete and Submit the Nomination
Packet
The nomination packet is divided into six sections.
To facilitate review, the nomination packet should
be organized as follows:
Section A. Nominee Category Sheet
Section B. Nominee Information
Section C. Nominator Information
Section D. Background Information
NYSCEC: The Voice and Vision of Special Education
Section E. Supporting Documentation (including
two letters of recommendation)
Section F. Additional Documentation (optional but
encouraged)
Complete the entire nomination form, providing
specific information about the nominee. The more
complete and detailed the information, the better.
Make sure you provide information that addresses
the nominee’s achievements in the category in which
he or she is nominated.
Double-check that the nominee’s name is spelled
correctly on all materials, as it will be printed on his
or her Certificate of Accomplishment.
ELECTRONIC SUBMISSION IS PREFERRED.
To aid an electronic submission, the nomination
packet is a fillable form. You can type into the form
to complete all information. Additional requested
documentation will need to be provided in electronic
format, as appropriate, via scanning, youtube links,
.jpeg, .docx, or .pdf files, etc. This includes a print
quality head shot of the nominee in .jpeg format. All
files should be labeled clearly with the nominee’s
last name and the section of the packet that the documentation is being provided for. All electronic copies are to be submitted by September 20, 2014 to
Dr. Elizabeth Hall at [email protected]
Subject line: YES I CAN AWARDS Nomination
IF SUBMITTING HARD COPIES:
Submit three collated copies of all nomination materials and one 5” x 7” high-resolution color headshot photo of the student to
Dr. Elizabeth Hall
SUNY GENESEO
1 College Circle
South Hall 220B
Geneseo, NY 14454
The photo must be print-quality. Please write the
student’s name on the back of the photo.
Place each nomination packet in a separate softbound folder (presentation folder, file folder, or
spiral or loose-leaf binder).
Include a table of contents as well as tabbed and
titled dividers for each section. Please label the
sections by information type. For example, the first
label should read “Nominee Category Sheet.”
Put the nominee’s name and award category on the
front of each nomination packet.
* AWARD NOMINATIONS WILL BE ACCEPTED THROUGH OCTOBER 10th *
2014 Yes I Can! Awards
Awards Nomination Form
All applications, whether submitted electronically and must be typed using a 12-point font. Handwritten forms
will not be reviewed.
All nominations must be postmarked no later than September 20, 2014.:
Dr. Elizabeth W. Hall
[email protected]
Please identify subject line as “2014 YES I CAN! AWARD NOMINATION”
Section A: Nominee Category Sheet
Name of Nominee: ____________________________________
Please check only ONE category of achievement.
ACADEMICS: achievement in a particular subject area such as math, science, reading, social studies, language arts, or foreign language; overall academic achievement; or a high level of achievement on standardized
tests.
ARTS: achievement in a particular medium such as music, art, drama, dance, or written expression.
ATHLETICS: achievement in a particular athletic activity through a setting such as intramurals, Special
Olympics, physical education classes, or after-school athletic activities.
SCHOOL AND COMMUNITY ACTIVITIES: achievement in organized activities at the school or community level through groups such as school-based clubs/activities (yearbook, theater, debate, tutoring, peer mentoring, social, service) or community-based clubs/activities (volunteer work, Boy/Girl Scouts, places of worship, service, cleanup campaigns).
SELF-ADVOCACY: achievement in assuming practical responsibility for oneself, using knowledge of legal
rights, advancing one’s goals, or effectively obtaining appropriate accommodations for oneself or others.
TECHNOLOGY: significant achievement through the use of assistive and adaptive technology devices and
equipment (computerized or otherwise).
TRANSITION: achievement in mastering activities that lead to successful experiences in the areas of:
a) work, b) vocational training, or c) independent living. Nominations should be made in only one of the three
areas; please indicate here: ___________________________
Please ensure that all information provided in the application is current as of September 20, 2014. NYSCEC uses
information on the nomination form for all future correspondence and publicity.
Section B: Nominee Information
Please type your responses on the nomination form.
Full Name of Nominee
(please check spelling)
Street Address
City, State/Province, Country
Zip/Postal Code
Nominee’s Gender
Nominee’s Age
Nominee’s Birthdate
Nominee’s Disability
Parent/Guardian Name(s)
Home Phone
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Work Phone
Cell Phone
Parent/Guardian E-mail Address
Nominee’s School and Grade Level
School District
School Phone Number
School Fax Number
Principal’s Name
Principal’s E-mail Address
Please indicate whether a Braille or
large-print certificate is needed.
Section C: Nominator Information
Name of Nominee: ____________________________________
Nominator’s Name
Street Address
City, State/Province, Country
Zip/Postal Code
Home Phone
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Work Phone
Cell Phone
Fax Number
E-mail Address
How do you know the nominee?
Are you a CEC member?
If yes, please provide your CEC ID number
If this nomination is being made by a
NYS CEC chapter, please indicate the
name and number of the chapter.
How did you hear about the Yes I Can!
Awards?
Nominator’s Signature
Date
The Certificate of Accomplishment will be sent to the nominator, not the nominee.
For part D 1, 2, and 3, please cut and paste your response from a word document using 12pt font.
Section D: Background Information
Name of Nominee: ____________________________________
Responses to the questions below must be typed and double-spaced in a 12-point font. Please use one inch margins and 12 pt. font. Handwritten forms will not be reviewed.
1. Background Information
A. Describe in 150 words or less, the challenges this student encountered prior to his or her current
accomplishments (e.g., difficulty with reading).
B. Describe in 150 words or less, the current type of special education services provided to the nominee (e.g.,
general education class with special education consultation, inclusion, special education classes).
2. Describe the student’s accomplishments in the category in which he or she is nominated.
(Consider creativity, innovation, and significance of the student’s accomplishments to the individual
and others.)
A. Describe in 150 words or less, the student’s achievements and accomplishments. You can add appendices
demonstrating examples of the student’s achievement.
B. Describe the setting in which the accomplishments occurred (i.e., home, school, community, work).
C. Describe in 150 words or less the impact of the student’s accomplishments on him or herself and others.
3. Systems Supports
A. In 100 words or less, describe how your community or school system supported this student.
For publicity purposes, please include the following information.
The nominee’s local newspaper_______________________________________________
Address__________________________________________________________________
City_______________________________ State ________________ Zip______________
Telephone Number ( ____) _________________ Fax ( __) _________________________
E-mail__________________________________
Section E: Supporting Documentation
1. The nominations packet must include two letters of recommendation. One letter must come from a professional
educator (e.g., teacher, principal, school administrator, counselor, consultant, educational assistant). The
second letter may come from an educator or other individual who knows the student well (e.g., teacher,
principal, counselor, parent, student).
The letters should state why the student deserves the award, particularly in the area in which the student is
nominated, and any obstacles the student has overcome.
Please label each of the letters as Section E: Supporting Documentation Letter 1, etc.
2. Suggested supporting documentation for each category:
Please label each of the pieces of supporting documentation as Section E: Supporting Documentation Academics Page 1, etc.
Academics—school transcripts, report cards, accelerated programs, academic awards, work samples, statement of change in student’s academic achievement.
Arts—electronic copies of artwork, event programs, youtube links of performances or CDs/DVDs of music,
dance performances, drama performances, etc. Items that cannot be provided via electronic format should be
mailed to Dr. Elizabeth Hall, SUNY GENESEO, South Hall 220B, 1 College Cir., Geneseo, NY 14454.
Athletics—awards, teams participated in, statements from athletic directors or P.E. teachers.
School and Community Activities—record of activities, statements from activity leaders, certificates, awards.
Self-Advocacy—statement of how the student educates others (teachers, students, community) on their needs
or the needs of others with disabilities; examples of the accommodations the student has requested to enhance
learning and accessibility.
Technology—record of technology used, how it has impacted the student or others, skills the student has
learned through technology use.
Transition—employment history, performance reviews, certificates, awards, statement of achievement from
employers/co-workers/teachers/coaches/transition officers, record of progress made in acquiring work, vocational, or independent living skills.
Section F: Photo Release
Photograph and Publicity Release Form YES I CAN! AWARDS
New York State Council for Exceptional Children
I, __________________________________________________________________, give
the New York State Council for Exceptional Children permission to use my name (if age 18
or older)
or my child’s name __________________________________________(if under age 18),
likeness, image, voice, and/or appearance as such may be embodied in any pictures,
photos, video recordings, audiotapes, digital images, and the like, taken or made on behalf
of the New York State Council for Exceptional Children Annual Conference 2014 YES I
CAN! Award activities. I agree that the New York State Council for Exceptional Children
has complete ownership of such pictures, etc., including the entire copyright, and may use
them for any purpose consistent with the New York State Council for Exceptional
Children’s missions. These uses include, but are not limited to publication in their journal
Exceptional Individual, submission to the national YES I CAN! Awards conducted by the
Council for Exceptional Children, reproductions on the New York State Council for
Exceptional Children website, publications, and advertisements for YES I CAN! Awards, in
any medium now known or later developed, including the Internet. I acknowledge that I
will not receive any compensation, etc. for the use of such pictures, etc., and hereby
release the New York State Council for Exceptional Children and its agents and assigns
from any and all claims which arise out of or are in any way connected with such use.
I have read and understood this consent and release.
I give my consent to the New York State Council for Exceptional Children to use my
name and likeness, or my child’s name and likeness, to promote the YES I CAN! Award
program, and my, or my child’s, participation in the program.
___________________________________________
signature
(if nominee is age 18 or older)
__________________
date
___________________________________________
parent / legal guardian (if nominee is under age 18)
___________________
date
I do not give my consent to the New York State Council for Exceptional Children to use
my name and likeness to promote the YES I CAN! Award program or my or my child’s
participation in the program.
___________________________________________
signature
(if nominee is age 18 or older)
__________________
date
___________________________________________
parent / legal guardian (if nominee is under age 18)
___________________
date
Section G: Additional Documentation (Optional)
Following are suggestions for additional documentation that may be provided:
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Candidate’s personal comments on achievement (highly recommended)
Newspaper articles
Documentation of other awards or recognition for achievement
Other relevant information about the nominee
Please ensure that ALL information provided in the application is current as of September 20, 2014. CEC uses
information on the nomination form for all future correspondence and publicity.