Award Nomination Form

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[av_heading tag=’h2′ padding=’10’ heading=’Character Education Awards Program Teacher Nomination’ color=” style=’blockquote modern-quote’ custom_font=” size=” subheading_active=” subheading_size=’15’ custom_class=’text_shadow1′ av_uid=’av-6a3sbs’][/av_heading]

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Please fill out the form below. If you would rather download the form and mail it in, please click here.
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[av_contact email=’jennifer@uncommonfriends.org’ title=” button=’Submit’ on_send=” sent=’Thanks for contacting us! We will get in touch with you shortly.’ link=’manually,http://’ subject=’Nomination Application: Champion Teacher Award’ autorespond=” captcha=” form_align=” color=” custom_class=” av_uid=’av-5xqgow’]
[av_contact_field label=’Nominee’s First Name’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-5rkl1c’][/av_contact_field]
[av_contact_field label=’Last Name’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-jtotk’][/av_contact_field]
[av_contact_field label=’Phone’ type=’text’ options=” check=’is_phone’ width=’element_half’ multi_select=” av_uid=’av-5dy914′][/av_contact_field]
[av_contact_field label=’Email’ type=’text’ options=” check=’is_email’ width=’element_half’ multi_select=” av_uid=’av-56sfe8′][/av_contact_field]
[av_contact_field label=’Nominee’s Home Address’ type=’text’ options=” check=’is_empty’ width=” multi_select=” av_uid=’av-52yybk’][/av_contact_field]
[av_contact_field label=’Address Line 2′ type=’text’ options=” check=” width=” multi_select=” av_uid=’av-4wky88′][/av_contact_field]
[av_contact_field label=’City’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-4s3j9s’][/av_contact_field]
[av_contact_field label=’State / Province / Region’ type=’text’ options=” check=’is_empty’ width=’element_fourth’ multi_select=” av_uid=’av-gcsog’][/av_contact_field]
[av_contact_field label=’Zip / Postal Code’ type=’text’ options=” check=’is_empty’ width=’element_fourth’ multi_select=” av_uid=’av-4fz6xs’][/av_contact_field]
[av_contact_field label=’Country’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-4akdtk’][/av_contact_field]
[av_contact_field label=’Space’ type=’html’ options=” check=” width=” multi_select=” av_uid=’av-42nli8′][/av_contact_field]
[av_contact_field label=’School’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-3ym1jc’][/av_contact_field]
[av_contact_field label=’Grade Level / Subject’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-3rrd4w’][/av_contact_field]
[av_contact_field label=’Supervising Administrator’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-3mog9c’][/av_contact_field]
[av_contact_field label=’Administrator Phone’ type=’text’ options=” check=’is_phone’ width=’element_half’ multi_select=” av_uid=’av-3d53x4′][/av_contact_field]
[av_contact_field label=’Uncommon Friends Foundation Curriculum Training: years/months’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-39k4eg’][/av_contact_field]
[av_contact_field label=’School Years of Uncommon Friends Foundation Curriculum Use’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-3201nc’][/av_contact_field]
[av_contact_field label=’Nominator’s First Name’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-aaxbc’][/av_contact_field]
[av_contact_field label=’Last Name’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-2o2z2g’][/av_contact_field]
[av_contact_field label=’Phone’ type=’text’ options=” check=’is_phone’ width=’element_half’ multi_select=” av_uid=’av-2msdlk’][/av_contact_field]
[av_contact_field label=’Title/Position’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-2cljkw’][/av_contact_field]
[av_contact_field label=’Nominator’s Address’ type=’text’ options=” check=’is_empty’ width=” multi_select=” av_uid=’av-2a0jl4′][/av_contact_field]
[av_contact_field label=’Address Line 2′ type=’text’ options=” check=” width=” multi_select=” av_uid=’av-225uw0′][/av_contact_field]
[av_contact_field label=’City’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-1y2yb4′][/av_contact_field]
[av_contact_field label=’State / Province / Region’ type=’text’ options=” check=’is_empty’ width=’element_fourth’ multi_select=” av_uid=’av-1ovlao’][/av_contact_field]
[av_contact_field label=’Zip / Postal Code’ type=’text’ options=” check=’is_empty’ width=’element_fourth’ multi_select=” av_uid=’av-1nabkg’][/av_contact_field]
[av_contact_field label=’Country’ type=’text’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-511o0′][/av_contact_field]
[av_contact_field label=’Line Break’ type=’html’ options=” check=” width=” multi_select=” av_uid=’av-17hpns’][/av_contact_field]
[av_contact_field label=’Email’ type=’text’ options=” check=” width=’element_half’ multi_select=” av_uid=’av-3nd34′][/av_contact_field]
[av_contact_field label=’Fax’ type=’text’ options=” check=” width=’element_half’ multi_select=” av_uid=’av-v74sg’][/av_contact_field]
[av_contact_field label=’Describe how the nominee has implemented the Uncommon Friends Foundation curriculum in his/her classroom for two or more school years.’ type=’textarea’ options=” check=’is_empty’ width=” multi_select=” av_uid=’av-rpze0′][/av_contact_field]
[av_contact_field label=’Describe how the nominee inspires in students the Uncommon Friends’ characteristics of a spirit of adventure, sense of purpose, and a capacity for growth through use of the character education curriculum lessons.’ type=’textarea’ options=” check=’is_empty’ width=” multi_select=” av_uid=’av-l3yps’][/av_contact_field]
[av_contact_field label=’Please provide any additional information about the nominee that the selection committee should consider when reviewing this nomination.’ type=’textarea’ options=” check=’is_empty’ width=” multi_select=” av_uid=’av-1gt5k’][/av_contact_field]
[av_contact_field label=’Note’ type=’html’ options=” check=’is_empty’ width=’element_half’ multi_select=” av_uid=’av-8d0c8′]
Note: A letter endorsing this nomination must be submitted by mail or email by the nominee’s administrator.
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