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Florida Unique Abilities Partner Program Nomination Form
Unique Abilities Partner Program Home
Note: Businesses cannot nominate themselves, but can apply directly for a Unique Abilities Partner designation by submitting the Unique Abilities Partner Program Application Form. An asterisk (*) denotes required information.
Business Information:
*
Name of the Business:
Physical Address of the Business:
Address:
City:
State:
--None--
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AS
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AR
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CT
DE
FL
GA
GU
HI
ID
IN
IA
KS
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IL
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MI
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OR
PA
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SC
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VI
UT
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Postal Code:
Contact Person at the Nominated Business:
First Name:
Last Name:
Title:
Phone Number:
Email Address:
(*Email
OR
Phone Number is required)
Contact Information for Person Submitting the Nomination:
First Name:
Last Name:
Relation to Business:
Phone Number:
Email Address:
Please select all Eligibility Criteria that you believe apply to the Nominated Business:
(*Selection of at least one criterion is required)
A. Employment of at least one individual with a disability. Such employees must be residents of Florida and must have been employed by the business for at least nine months before the business applies for a Unique Abilities Partner designation.
B. Contributed to local and/or national disability organizations or made contributions in support of individuals who have a disability. Such contributions may be financial or in-kind, including employee volunteer hours. A business with 100 or fewer employees must make a financial or in-kind contribution of at least $1,000 and a business with more than 100 employees must make a financial or in-kind contribution of at least $5,000.
C. Established or contributed to the establishment of a program that contributes to the independence of individuals who have a disability. A business with 100 or fewer employees must make a financial or in-kind contribution of at least $1,000 in the program and a business with more than 100 employees must make a financial or in-kind contribution of at least $5,000.
If you are completing a hard copy nomination, please mail the nomination form to:
Unique Abilities Partner Program
Department of Economic Opportunity
107 East Madison Street
MSC G-229
Tallahassee, FL 32399