District Service Award - Active Nomination Form

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NORTHWESTERN OHIO EDUCATION ASSOCIATION DISTRICT SERVICE AWARD ACTIVE NOMINATION FORM

Please fill out the form completely. Incomplete forms will not be considered. Only this format will be accepted.

This is a NOMINATION. It does not guarantee the person will receive an award.

Guidelines: District Service Award- Active Guidelines

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Correo electrónico *

Name of Nominee *

Nominee's Phonetic Spelling of Name *

Nominee's Local Association (no abbreviations) *

Nominee's Position in Local Association
*

Nominee’s Teaching/Support Assignment
*

Nominee's Place of Employment
*

Nominee's Complete Home Address with City, State, and Zip Code *

References – Reference #1

NAME, OCCUPATION, ADDRESS, and TELEPHONE

References – Reference #2

NAME, OCCUPATION, ADDRESS, and TELEPHONE

References – Reference #3

NAME, OCCUPATION, ADDRESS, and TELEPHONE

Name of Person making the Nomination *

Nominator's Local Association (no abbreviations) *

Nominator's Position in Local Association *

Nominator's Complete Home Address with City, State, and Zip Code *

Nominator's email address *

Nominator's phone number *

Give the name and address or online link to submit information of one local newspaper that NWOEA may notify for publication of award information.

I give my permission as nominator that NWOEA may contact the nominee for additional information if needed.

Yes

No, Contact me first

Explain in one or two sentences what this nominee has done for your district to prompt you to nominate him/her for this award.

Please provide information on how the nominee meets the criteria for the award. List ONLY SERVICE TO THE NWOEA DISTRICT. Be specific. (District Committees, NWOEA Board of Directors, NWOEA Representative to OEA Committees/Commissions and NEA Committees.)

List the Nominee’s community activities, organizations, and honors. Be specific!

Please provide additional detailed information you feel has not been covered in the previous sections of this application form, including service at local association and UniServ levels.

Online SIGNATURE of NOMINATOR

By checking this box, I agree that I as the Nominator, I have completed this form online. ( This takes the place of a signature.)

I will call the NWOEA Center to ask questions about the signature for completing this form. 419-424-1708

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