Annual Governor’s Excellence in Community Action Award Nomination Form

Please complete all fields and submit by February 25, 2022. Incomplete nominations will not be considered. Any questions should be sent via email to Anna Sainsbury at anna.sainsbury@wisconsin.gov.

A selection committee with evaluate all nominations in accordance with the selection criteria. Nominees will be notified via email once all nominations are reviewed. The winner will be presented with the award during the WISCAP virtual award ceremony scheduled for May.


Please include a narrative that addresses the following areas of focus for this year's award.

Innovation in Programming (20 points) - Describe the innovative approaches your agency and/or the program/project uses to meet the needs of low-income people and/or communities. If this is a new program/project, describe how the need for such program/project was evaluated. If this is an ongoing program/project, describe how it is being leveraged.

Reducing the Causes and Conditions of Poverty (20 points) - How does the program/project help low-income households achieve emergency or impactful assistance? Collaborative Partnerships (20 points) - Describe the extent to which your agency collaborates with other community organizations, groups, and local/county/state governmental units in order to deliver the program/project to the community.

Community Impact (20 points) - Describe the impact your program/project is currently having on the community/communities it is targeting.

Leveraging Resources (10 points) - Describe the extent to which your agency seeks out and uses resources to assist in the implementation and execution of its program/project. Include both financial and non-financial resources, as applicable.

Effectiveness (10 points) - Describe any aspects of your program/project that are cost effective, sustainable, or scalable on a larger level.