5th Annual Bart Hultine Altruism Fund Nomination Form

The recipient of the 5th Annual Bart Hultine Altruism Fund, Inc. (BHAF-a non-profit organization) "Excellence in Vocational Rehabilitation" Award and Stipend will be announced at the 2015 International Association of Rehabilitation Professionals (IARP) 2015 International Conference, Unmask Your Potential, in New Orleans, LA on Saturday, October 22-24, 2015. Recipient does not need to be present at the conference to receive the award and stipend.

The BHAF recognizes individuals, businesses, agencies and efforts that have made an outstanding contribution to the field of vocational rehabilitation. Recipients receive an award and a $500 cash stipend.

The BHAF is seeking nominations for the annual award and stipend by September 15, 2015. Examples of nominees MAY include but are not limited to:

• Individuals that have overcome a barrier(s) to employment
• Professionals working with and/ or advocating for people with barriers to employment
• Businesses/ Employers that have provided innovative work opportunities for people with barriers to employment
• Individuals that have contributed to the field of vocational rehabilitation or the promotion of the vocational rehabilitation profession

Please complete the form below and submit your nomination.

Name of person making the nomination

Contact Inofrmation

Name of nominee

Contact Information

Describe/Explain why you believe the nominee is a candidate for the award and stipend

May we contact the nominee for additional information if nominee is selected?

- Yes- No

If your nominee is chosen may we share your name with the nominee?

- Yes- No

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You may fax, email or mail your nomination to:

The Bart Bultine Altruism Funs, Attn: Michelle Hultine, 101 S. Hastings Ave., Hastings, NE 68902
Fax (402) 463-6992 Email This e-mail address is being protected from spambots. You need JavaScript enabled to view it

If you would like more information about the nomination and award process, please contact:

MIchelle Hultine, (402) 463-6887 x211 or This e-mail address is being protected from spambots. You need JavaScript enabled to view it

BHAF Board of Directors

Ifyou would like to make a donation to The BHAF please visit www.hultine.com/bhaf or send to 101 S. Hastings Ave, Hastings, NE. You will receive a receipt for your tax deductible donation.