Jake Rockeman Award Nomination form
The Community Advisory Committee for Special Education, West Contra Costa Unified School District
Sign in to Google to save your progress. Learn more
Email *
The Jake Rockeman Award will be presented to a student during the You Make a Difference Awards Ceremony on March 8, 2024
The Jake Rockeman Award was created in honor of a nine year old boy who passed away in 2003. Jake was a student in our district, who despite his diverse disabilities, touched the lives of many.  His parents were very involved in his life and volunteered in many capacities in the district as well as the community. Jake is missed by all who knew him.

The CAC presents this award to students in WCCUSD who have gone out of their way to support their special education peers in any of the following ways.

         Have been inspired by a special education student
         Have given support to a special education student
         Have made an outstanding contribution to a special education student
         Have been a positive role model to a special education student
         or
         Have helped promote inclusion with the general education community  

Please submit the name of any deserving student and provide a description of their contribution.  Nominations are due by December 15, 2023
Student Name *
School *
Grade *
Student's Mailing Address ( if known)
Parent's Name (if known)
Nominator *
Mailing Address *
Phone number (where you can be easily reached) *
Please use this space to describe this student's contributions and why you believe they are deserving of this award.   *
Submit
Clear form
Never submit passwords through Google Forms.
reCAPTCHA
This form was created inside of West Contra Costa Unified School District. Report Abuse