Shining Star Nomination Form

The Shining Star Award 2016

2016 Recognition for Excellence in Special Education Nomination Form

To nominate, please use this form and mail to:

Westfield SEPAC

Special Services

94 N Elm St. Suite 201

Westfield, MA  010805

 

Instructions:

Complete the form below and attach a nominating statement of 500 words or less postmarked by Thursday, May 12,2016.

 

Nomination forms are also on the SEPAC’s Facebook page: Westfield MA Special Education Parent Advisory Council.

 

Name of Person Nominated*:___________________________________________________

 

Name of School where nominee attends/works*:

____________________________________________________________________________________

 

Nominee Contact Information*

Please include school information in order to contact the nominee.

Email: _______________________________________________________________________________

Position/Role:_________________________________________________________________________

 

Nominated By*

Name of Person Submitting Nomination: ___________________________________________________

Email: _______________________________________________________________________________

Address: _____________________________________________________________________________

 

Would you like your name to be kept confidential?   Yes  or  No   (Please circle one)

 

NOMINATING STATEMENT*

Attach a nominating statement of no more than 500 words explaining how the nominee deserves special recognition.  Your statement should include specific details of how this person goes the extra mile to serve the special education community.  Supporting statements from students and/or parents/guardians can be included.

 

*Required information