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2. Business Name *
4. Business Address*
6. City
7. State
8. Zip
10. Your Name*
12. Your Email Address*
14. Your Phone Number
16. What features does this business offer? *

    Check all that apply.

    1. Step-free entry and/or wheelchair ramp
    2. ADA-compliant restroom
    3. Wide, navigable aisles and spaces
    4. Accessible parking nearby
    5. Clear signage or braille options
18. How does the staff engage with the disability community?*

    Check all that apply.

    1. Respectful and accommodating service
    2. Staff trained in disability awareness
    3. Willing to adapt services to individual needs
20. Which of these features are available at this business? *

    Check all that apply.

    1. Braille menus, captioning, or other formats
    2. Quiet or sensory-friendly hours
    3. Welcomes service animals without issue
22. Does the business support inclusive employment?

    Check all that apply.

    1. Hires people with disabilities
    2. Partners with organizations for inclusive hiring
24. How does this business support the wider community?

    Check all that apply.

    1. Sponsors disability-related events or groups
    2. Promotes inclusive values and messaging
    3. Welcomes and responds to feedback
26. Does the business have any special accessibility features or make any special efforts that you want to highlight?

    Check all that apply.

    1. Uses adaptive technology or innovative solutions
    2. Creates a welcoming, inclusive culture
28. Why are you nominating this business? *

    Share a story or provide an example of how this business made a difference.

30. Upload a photo (optional)

    You may upload a photo of the business or an experience at this business. 

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32. 1. Receive an email copy of this form.
33. Email address

    This field is not part of the form submission.

34. Submit

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