Local Service Award Nomination Form

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NORTHWESTERN OHIO EDUCATION ASSOCIATION 2023-24 LOCAL SERVICE AWARD NOMINATION FORM

Please fill out the form completely. Incomplete forms will not be considered. This nomination form must be submitted to the NWOEA Center by January 11, 2024. Any questions can be emailed to nwoea.center@gmail.com.

The recipients will be notified and invited after February 1, 2024 to be recognized at the Awards Reception (Findlay Country Club on March 12, 2024).

Only this online format will be accepted. This is a NOMINATION. It does not guarantee the person will receive an award.

Guidelines : Guidelines for Local Service Award Nomination

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Courriel *

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 local association to prompt you to nominate him/her for this award.

Describe the outstanding service this nominee has provided your local association by detailing offices/positions held and citing length of time served with special emphasis to unusual and/or exceptional contributions.

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. (For example, community activities, organizations, honors, etc.)

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

Obligatoire

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