Champions for Public Education nomination form

Name of school district *

Today's date

Name of person, organization, business, etc. being nominated *

being If Name

If nominee is an organization or business, name of key contact person

Address of nominee *

Telephone number of nominee *

Board member or district staff member completing form *

Telephone number of person completing form *

District size (for demographic purposes only)

Board chairman's signature *

Board chair enters initials to sign.

Upload support materials to accompany nomination

Drag & Drop Files, Choose Files to Upload You can upload up to 3 files.

You may upload a total of 3 files of no more than 6Mb each. File types accepted are Word (.doc, .docx) and Adobe Acrobat (.pdf).