Veronica Awards — Nomination Form
1.1. Superstar Awards are made to individuals who provide direct services to individuals and families. Please indicate the following about the nominee: (EXCLUSIVE CHOICE)
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He/She is a front line staff member who provides direct services
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He/She is a in a management or supervisory role but also carries a caseload or dedicates at least 50% of my time to direct service
1.2. Indicate the program or programs in which he/she works (check all that apply):
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Modality of Service: One-on-One Services
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Modality of Service: Group Based
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Modality of Service: Family
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Target Population: Supplemental/Out of School student services
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Target Population: Disconnected youth
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Target Population: Seniors services
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Target Population: Homeless/Residential services
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Target Population: Workforce Readiness/Employment
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Target Population: Justice & Corrections (Adult or Juvenile) – prevention/reentry
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Target Population: Financial Literacy/Counseling
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Target Population: Foster Care/Child Welfare
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Target Population: Mental and/or Behavioral Health
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Target Population: Substance Abuse
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Target Population: Other Vulnerable Populations:
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Type of Service: Tutoring
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Type of Service: Mentoring
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Type of Service: Home Visitation
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Type of Service: Work Readiness Training
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Type of Service: Cognitively Based Therapy
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Type of Service: Case Management
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Type of Service: School Based
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Type of Service: Out of School Programming
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Type of Service: Creative/Expressive Activity
1.3. What is the typical period of service for an individual or family in your program?
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1 Day or less
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1 Week or less
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1 Month or less
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6 Months or less
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1 Year or less
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More than 1 year
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Until intended outcomes are achieved
1.4. What is the typical size of the nominee’s caseload/cohort/class?
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Under 15
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15-25
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26-35
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36-45
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> 45
1.5. What is the typical frequency of contact and documented engagement with participants who are on the nominee’s caseload/cohort/class?
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Multiple Times per Week
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At Least Once a Week
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At Least Every Other Week
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At Least Once a Month
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Less Than Once a Month
2.1. What is your organization's theory of change or philosophy? How do you apply this to YOUR work with clients and how do you know you are making a difference with your clients? Please provide at one example. (10 Possible Points)
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2.2. (Recommend Supervisor Answers): Why is this nominee a Superstar? From a data and/or outcomes perspective, how does s/he compare to their peers? Please specify how the nominee uses data to monitor incremental progress, do something different based on data, and/or improve quality of service based on data. (10 Possible Points)
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2.3. In a bulleted list, provide examples of outcomes you track that demonstrate the lasting changes you have with your participants. Please also provide how you measure these outcomes. Additionally, include examples of how you track the quality of services provided (which could also be participant satisfaction data, and/or program fidelity data.)
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2.4. Most importantly, please describe how the nominee uses the data listed previously in order to adjust their work to improve each participant's achievement of intended outcomes. Be specific with examples. Provide a sense of how often data is reviewed, and how it is specifically applied to drive performance. (20 Possible Points)
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2.5. Please provide three professional references who have worked with the nominee (at least one in a supervisory capacity). Please note: The Superstar Foundation will likely contact all three if you are in serious consideration for an award.
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3.1. Based on the answers provided above, upload non-anecdotal evidence and/or data that draws attention to the nominee's effectiveness. Comparative data with other staff serving in the same role is encouraged. As possible, please ensure that data provided is attributable to the nominee. Our Superstar Judges have experience in the field of human services but the more simple the files are to understand (including labels, etc...) the better.
ALL DATA MUST BE DE-IDENTIFIED- Please make sure that any data that you submit that shows individual client outcomes or performance is de-identified, meaning that it does not include anyone's name, address, phone number, Social Security number or any other data that can be associated with a specific individual or family. (60 Possible Points)
Our judging panel will use the following criteria to evaluate the data set:
- Is the data provided specific to the nominee or does it more broadly address program results? (Data specific to the nominee is highly preferred)
- Is the data outcome information, service information or a combination of service information and outcome information? (Outcome data - data reflecting sustained change over time as a result of the service intervention- is highly preferred)
- Does the data provided come with explanations/bullet points to highlight the nominee’s performance?
- Is the data comparative with the nominee’s peers? (Comparative data demonstrating superior performance is highly preferred)
- Is the data provided aggregate/summary in nature and is there evidence that the data is monitored by the organization to assess staff level performance?
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What is the specific time period for the data submitted? (Data can be for any time period in the last year)
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How many participants represented in the data set were served by the nominee in the time period noted?
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Is the data set specific only to the nominee's work or are other direct service workers' efforts reflected in the data?
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