work-life balance nomination form

If you don't know all of the information about the business you want nominated, provide us with the company and a contact (even if it's not the right one - we'll find them). A more detailed form will be sent to the company you've nominated.

Entry deadline is November 14, 2008. It only takes a few minutes to make a nomination.

If you have any questions concerning the nomination process please contact Geania Dickey at geaniadickey@aol.com or 501-407-0720.

To read our FAQ's on the Awards, please click here.

Organization Name:
# of Employees in Arkansas:
# of Employees Nationwide:

Health and Welfare Benefits		Career Development		Elder Care Assistance
	Medical Plan		Career assessment		Resource and referral
	Dental Plan		Career development program		Employer subsidized elder care
	Vision  Plan		Cross-training		Caregiver seminars
	Prescription drug plan		Mentoring		Long-term care insurance
	Part-time employee benefits		Education reimbursement
	Paid sick leave		Sabbaticals	Wellness
			"Brown-bag" seminars		Discounts to health club and/or on site fitness options
Reimbursement Accounts			Mature workers		Health education programs
	Health care reimbursement account	Infant Care
	Dependent care reimbursement account		Lactation room (breastfeeding)	Work Place Culture
			Paid leave/parental		Surveying employees on work-life issues
Retirement Plans			Unpaid family leave beyond requirement of FMLA		Self-managing work teams
	401(k) or 403(b)				Quality improvement program
	Retirement plan other than 401(k)or 403(b)	Child Care Assistance			Paid time off for volunteer activities
			Resource and referral programs		Policy statement regarding commitment to work-life balance
Work-Time Options			Employer subsidized child care
	Flexible work scheduling		Use of employee sick days to care for dependents
	Compressed work week		Financial assistance to adoptive parents
	Permanent part-time schedule		On or near-site child care
	Telecommuting		Family child care network
	Job sharing

Mature Workers
	Organizational communications regarding mature worker job recruitment activities
	Training is provided regarding age discrimination laws
	Mature workers have access to flexible training opportunities
	Mature workers have access to employer-supported training and professional development activities
	Mature worker promotional opportunities
	Provide appropriate accommodations as needed for mature workers in their work environment
Other

To complete your survey, a representative will follow-up with you to gather more detailed information on the programs.  Please provide the following information:

Your Contact Info Company Contact Info Contact Name: Contact Name: Job Title: Job Title: Email: Email: Phone: Phone: Mailing Address: Mailing Address: City: City: State: State: Zip Code: Zip Code: