NOMINATION FORM FOR GT SERVICE AND ADVOCACY AWARD 2017
Nominee’s Name: (Dr. Mr. Mrs. Ms.) _____________________________________________________________
Home Address: ______________________________________ City/State/Zip ______________________________
Home Phone: __________________________________Work Phone: _____________________________________
Email Address: _________________________________________________________________________________
Years of experience with gifted: _______________________ in what capacity? _____________________________
Nominated by: (Dr. Mr. Mrs. Ms.) _______________________________________________________________
Home Address: ________________________________________ City/State/Zip ____________________________
Home Phone: ____________________________________Work Phone: ___________________________________
Relationship to the nominee: _____________________________________________________________________
Please answer the following questions in detail. Describe accomplishments and information concerning why the nominee should be considered for this award. Additional pages may be used.
- What specific contributions has the nominee made toward gifted students, parents, and/or educators of gifted students within the nominee’s everyday classroom and/or school setting?
- Describe the impact of these contributions.
- Explain the extent of advocacy for gifted services within the nominee’s everyday classroom and/or school setting.
Please return completed application by March 1, 2017, to:
Supt. Marion Sowders
1922 North US 127
Liberty, KY 42539
phone: 606.787.6941, email: email@example.com, fax: 606.787.5231