Black Administrators in Child Welfare Annual National Conference "Mapping Our Children’s Future in Today''s Economy" March 25-27, 2012, Renaissance, Fort Lauderdale Hotel at Fort Everglades in Ft. Lauderdale, Florida  Print Blank Form 2012 Valeria Bullard Black Administrator of the Year Nomination Form Nominee Name: Nominee Title: Nominee Agency/Organization: Nominee Street Address : Nominee City:   Nominee State:   Nominee ZipCode:  Nominee Phone: Nominee Fax: Nominee Email: Program Area(s) of Work: Length of Time in Current Position: Length of Time Working in Child Welfare Field: Brief Statement Describing Your Nominee's Qualifications (not to exceed 250 words): Nominator Name: Nominator Title: Nominator Agency/Organization: Nominator Street Address : Nominator City:   Nominator State:   Nominator ZipCode:  Nominator Phone: Nominator Fax: Nominator Email: All Nominations must be received by February 17, 2012. Nomination criteria Completed forms may be submitted on-line, by mail, or by fax. For submission by mail or fax, please submit to: BACW Attn: Rita Graham 900 Second Street, NE, Suite 202 Washington, DC 20002 Fax: 202-783-3716