• The ACPA Family Services Leadership Award recognizes an individual or group, such as a parent, patient, advocate, or community organization, who has demonstrated exceptional service and leadership on behalf of individuals with cleft or craniofacial conditions.

    • Healthcare/team professionals are not eligible to receive this award.
    • Nominees must have demonstrated exceptional service and leadership for no less than three years.
    • If a nominee is not selected in the year they are originally nominated, they will be included in the selection pool for up to two years following (with confirmation from the sponsors).
    • There is no obligation for the committee to select a winner.

    Instructions

    For the items below, please evaluate each nominee. Conclude with any additional comments you might like to share with the committee. The committee chair will select the award winner.

    *If you would like a copy of this evaluation for your records, you can download a PDF version after submission.*

  • Name * Required
  • Nominee identified unmet needs, lack of services, or lack of resources that impact the lives of individuals affected by craniofacial conditions and has taken action to meet those needs.
    OutstandingVery GoodGoodFairNot Acceptable
    NSU SLP NSSLHA Chapter
    Dina Zuckerburg
    Henry Baddour
    Amy Straub
    Dash for Smiles
  • Nominee has created, delivered, and/or enhanced programs or services that improve the lives of individuals with cleft or craniofacial conditions.
    OutstandingVery GoodGoodFairNot Acceptable
    NSU SLP NSSLHA Chapter
    Dina Zuckerburg
    Henry Baddour
    Amy Straub
    Dash for Smiles
  • Nominee has demonstrated an ongoing commitment to engaging in leadership and/or service for individuals with cleft or craniofacial conditions.
    OutstandingVery GoodGoodFairNot Acceptable
    NSU SLP NSSLHA Chapter
    Dina Zuckerburg
    Henry Baddour
    Amy Straub
    Dash for Smiles
  • Evidence of nominee's leadership or service is supported and documented by the sponsoring care providers.
    OutstandingVery GoodGoodFairNot Acceptable
    NSU SLP NSSLHA Chapter
    Dina Zuckerburg
    Henry Baddour
    Amy Straub
    Dash for Smiles