Church Recognition Award

Please print out this form, complete it and return with supporting documentation to:

CCPD Executive Director,
301 E. Pine St. Suite 150
Orlando, FL 32801
Phone: 407-210-3917
Fax: 407-835-3601

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Christian Council on Persons with Disabilities
Caring Church Recognition Award

Nominee (Name of church) ___________________________________________
Address __________________________________________________________
City/State/Zip ______________________________________________________
Phone (Please include area code) ________________________________________
Church's URL & Primary E-Mail ________________________________________
Senior Pastor _______________________________________________________
Name of contact person(s) at church _______________________________________
Years church has been involved with people with disabilities ______________________
Are church facilities (including entrance, meeting rooms, restrooms and various levels of the building) accessible? _______Yes __________No
How are people with disabilities integrated into the life of the church?:

How many people with disabilities are involved in church activities? _____________________
Please check all disabilities with which the parish is involved:
____ Physical Disability ____ Mental Illness ____ Hearing Impairments ____ Visual Impairments
____ Environmental Illness ____ Brain Trauma _____Learning Disabilities ____Age-Related Disabilities ____ Developmental Delays ____ Caregivers

How many parishioners are actively involved in welcoming, befriending and including persons with disabilities in congregational activities? ________________________________

Describe their involvement:

Does the church agree with the CCPD Statement of Faith? _____ Yes _____ No
Denomination with which church is affiliated ____________________________
Use additional paper to list your reasons for nominating this church. _______________________

Your name: ______________________________________ Phone:___________________________
Your address: _________________________________________________________________
City/State/Zip: ________________________________________________
Your E-Mail: ________________________________________________
Date: __________________________________________________
Please return this completed form, with supporting documentation, to:
CCPD
Attn: Executive Director
301 E. Pine St. Suite 150
Orlando, FL 32801
Phone: 407-210-3917
Fax: 407-835-3601