Name of Caregiver:
Address of Caregiver:
Phone Number of Caregiver:
E-mail Address of Caregiver:
Name of Nominator:
Address of Nominator:
Phone Number of Nominator:
E-mail Address of Nominator:
Attach the following materials to this application:
1. Describe the needs of the senior and provide examples of the
extraordinary actions of the caregiver.
You may also submit photos.
2. Sign the attached Certification.
* * * * * * * * * *
Application deadline: All materials must be submitted by mail or e-mail before April 1, 2013.
Mail application to:
Caregiver of the Year Award
c/o Cona Elder Law PLLC
225 Broadhollow Road, Suite 200
Melville, New York 11747
Attention: Moriah Farrell
OR e-mail to: firstname.lastname@example.org (please indicate Caregiver of the Year in the subject line.)
* * * * * * * * * *
2013 Caregiver of the Year Award Certification
I hereby certify that all of the statements contained and information provided in this application, and in the attachments hereto, are truthful, to the best of my knowledge.
I hereby grant permission for my name, photo and story to be included in any reputable media including newspaper, magazine, TV, radio as well as posted on the Cona Elder Law website. In addition, if requested, I agree to be interviewed by print and broadcast media.
Cona Elder Law is a full service law firm based in Melville, LI. Our firm concentrates in the areas of elder law, estate planning, estate administration and litigation, special needs planning and health care facility representation. We are proud to have been recognized for our innovative strategies, creative techniques and unparalleled negotiating skills unendingly driven toward our paramount objective - satisfying the needs of our clients.
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