BETTY ANN SIMON MEMORIAL AWARD

DOLLAR ENERGY FUND, INC.
BETT Y ANN SIMON
MEMORIAL AWARD
THE BETTY ANN SIMON MEMORIAL
AWARD WAS ESTABLISHED IN 2002 TO HONOR
THE MEMORY OF ONE OF DOLLAR ENERGY
FUND’S FOUNDERS, BETTY ANN SIMON.
Betty Ann Simon worked tirelessly for two decades directly addressing the daily
struggles faced by thousands of low-income households in Pennsylvania. From her
position as a founder in 1983, to her active service on the Board until her passing,
she focused on developing ways to immediately provide assistance to families facing
difficulties in affording safe and adequate utility supplies.
Betty Ann Simon was key in formulating the Vision of Dollar Energy Fund.
1. Create a community where every resident understands and accesses community resources
to solve their light, heat and water payment problems as a step toward greater self
sufficiency and;
2. All constituencies contribute to community efforts, which make heat, light, and water
resources available to low-income households as they transition to self sufficiency.
In memory of Betty Ann, Dollar Energy Fund would like to recognize a leader who has “made
significant contributions to the low income community through advocacy, low-income
program advancements, program creation, legislation, and program funding attainment that
have assisted Dollar Energy Fund clients and low-income clients throughout the state build a
path to self sufficiency.”
The winner of the Betty Ann Simon Award will be publicly recognized at Dollar Energy Fund’s
Annual Meeting. Also, Dollar Energy Fund will award the first utility assistance grant of the 20142015 program year in the name of the Betty Ann Simon Memorial Award recipient.
We invite you to nominate a community leader for this prestigious award. This is an excellent
opportunity to recognize leaders who strive to assist the low income community and make the world
a better place.
Submit completed
nomination forms to:
Dollar Energy Fund, Inc.
Attn: Michelle Haudrich
Fax #: 412-431-2085
OR
[email protected]
Please submit your completed nomination form no later than
Monday, August 4, 2014. You may fax the attached nomination form to
412-431-2085 or electronically submit the completed form to
[email protected].
BETT Y
ANN
SIMON
MEMORIAL
N o m i n a t i o n
AWARD
F o r m
Nomination Criteria & Eligibility:
Eligible persons are those who have “made significant contributions to the low income community
through advocacy, low-income program advancements, program creation, legislation, and program
funding attainment that have assisted Dollar Energy Fund clients and low-income clients throughout the
state build a path to self sufficiency.”
Nominees may include:
Government officials and employees;
Community leaders;
Religious leaders;
Corporate executives;
Non-profit leaders
Companies/organizations
Staff and Board members of the Dollar Energy Fund are not eligible.
Award:
The award will be two fold: 1) A plaque will be publicly presented to the winner on Friday, September 12,
2014, at Dollar Energy Fund’s Annual Meeting. 2) The first Dollar Energy Fund grant of the 2014-2015
program year will be awarded to the grant recipient in the name of the Betty Ann Simon Award winner.
Deadline:
All nominations must be submitted no later than Monday, August 4, 2014. Please submit completed
nomination forms to:
OR
Fax #: 412-431-2085
Electronically submit to: [email protected]
Attn: Michelle Haudrich
Please fully complete the three part Nomination Form below
ONE: Nominator
Nominator’s Name:
Nominator’s Organization:
Nominator’s Title:
Nominator’s Address:
Nominator’s Phone Number
Nominator’s Email Address:
TWO: Nominee
I nominate (full name)
Memorial Award.
for the 2014 Betty Ann Simon
Nominee’s Name:
Nominee’s Organization:
Nominee’s Title:
Nominee’s Address:
Nominee’s Phone Number
Nominee’s Email Address:
THREE: Nomination
Please answer the questions below (there is no limit to the length and the more descriptive you are, the
more fully the judges can consider the person for the award). Nomination answers can be submitted on
separate pages if more space is needed.
How do you know the individual/organization?
Why do you believe the individual/organization is a good fit to receive the Betty Ann Simon
Memorial Award?
Provide examples of the contributions the nominee has made to the low-income community as
well as any other information you feel illustrates the nominee’s commitment to the welfare of
low-income clients.
PLEASE ATTACH ADDITIONAL PAGES IF NEEDED.
The Winner and their nominator will be notified via telephone and mail.
Any Nomination questions should be directed to:
Michelle Haudrich, Dollar Energy Fund
412-353-1218
BETT Y ANN
SIMON MEMO RIAL AWARD FUND
D o n a t i o n
F o r m
THE FIRST GRANT OF EACH PROGRAM YEAR WILL BE GIVEN TO A
DESERVING FAMILY OR INDIVIDUAL IN THE NAME OF BETTY ANN SIMON
AND THAT YEAR’S BETTY ANN SIMON MEMORIAL AWARD RECIPIENT.
We would like to ask you to help us fund this award through a donation to the Betty Ann Simon
Memorial Award Fund. Your donation will help Dollar Energy Fund meet its mission to “improve
the quality of life for households experiencing hardships by providing utility assistance and
other services that lead to self-sufficiency.”
All donations will be used to provide the first grant of the program year and will be matched dollar for
dollar by one of Dollar Energy Fund’s partnering utility companies. This means that each dollar you
donate will turn into $2! One hundred percent of your donation and the matching funds will be
applied to the Betty Ann Simon Memorial Award Fund and will be given to an eligible family or
individual in the form of a grant applied directly to their utility bill. Your donation will directly assist an
eligible client restore or maintain their utility service. All donations are tax deductible.
Please help us continue the remarkable work that Betty Ann Simon started 30 years ago by
donating to her Memorial Award Fund.
You can donate to the Betty Ann Simon Memorial Award Fund through either of the methods below:
1. Mail a check made payable to Dollar Energy Fund to:
Dollar Energy Fund, Inc.
Box 42329
Pittsburgh, PA 15203
2. Donate on-line through Dollar Energy Fund’s website at www.dollarenergyfund.org.
Please contact Michelle Haudrich, at 412-390-3876 or [email protected] with any
questions.
Donation to the
BETTY ANN SIMON MEMORIAL AWARD FUND
Name: _________________________________________
Date: ________________________
Address: _______________________________________________________________________________
_______________________________________________________________________________________
Phone Number: _________________________________
Donation Amount: _____________
Please mail donations to: Dollar Energy Fund, Inc.; Box 42329; Pittsburgh, PA 15203
The Dollar Energy Fund is a 501 (c) (3) organization in the state of Pennsylvania. For your records, our tax ID number is 25-1442933/000.
The official registration and financial information of Dollar Energy Fund, Inc. may be obtained from the Pennsylvania Department of State by
calling toll free, within Pennsylvania, 1 (800) 732-0999. Registration does not imply endorsement.

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