Nominations, Sojourner Truth Awards

This form must be completed by the teacher/counselor who nominated the student, not by the student him/herself. A hard copy of this form will be shared with the student.

Student Information

School Name:
First Name:
Last Name:
Grade:

Student Address

Street Address/Mailing Address/P.O. Box:
City:
State:
Zip Code:

Nomination Information

Nomination Category:
Please describe specifically why you have chosen this student to be recognized for exceptional achievement in the designated category. (Please submit a minimum of 200 words. In order not to loose what you have typed, we advise that you type up and save this text in your word processor first. Then copy and paste it into this box.):

Who is submitting this form?

First Name:
Last Name:
E-mail Address:
Relationship to nominee: