Celebrate Literacy Award
Friday, April 9th, 2010Celebrate Literacy Award
Nomination Form
Please print or type the following information requested
Name of Nominee
Home Address:
Home Phone:
Nominee is: _____Employee _____Volunteer
School District/Agency:
Position:
Business Address:
Business Phone:
Please explain, on a separate sheet of paper, the specific program/service that is involved, the target population, the role of the nominee, how literacy is promoted, the length on time the nominee has been involved in the program/service, and the specific outcomes.
Name of Nominator(s):
Home Address:
Home Phone:
School District/Agency:
Position:
Business Address:
Business Phone:
Please list any references that could be contacted concerning this program/service and the nominee’s involvement.
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Name: Name:
Position: Position:
Address: Address:
Phone: Phone: |
Thank you for taking the time to complete this Celebrate Literacy nomination by April 20, 2010.
Please submit all information to Louise Rose, c/o Myers Corners Elementary School, 156 Myers Corners Road, Wappingers Falls, New York 12590.