Request edit access
Nomination form: Black Education Matters Student Activist Award
The Black Education Matters Student Activist Award fund offers a $1000 package to a deserving Seattle public school student who demonstrates exceptional leadership in struggles for social justice, and against institutional or structural racism. Student can nominate themselves, or can be nominated by a friend, teacher, coach, counselor, parent or others.
Seattle teacher Jesse Hagopian created this award with funds from his financial settlement with the City of Seattle obtained after he launched a federal lawsuit against the City and the Seattle Police Department when he was pepper sprayed at the Martin Luther King day rally in Seattle, 2015.
Criteria for selecting the awardee:
• Any student who has been enrolled for a semester or more in a Seattle public school.
• A student who has shown social justice leadership in struggles against racism—especially with an understanding of the intersections with sexism, homophobia, transphobia, Islamaphobia, class exploitation and other forms of oppression—within their school or community.
Application instructions: Nominees must submit required material by May 5, 2018, to be considered for funding.
• Applicant or nominee name and other requested information, see below.
• Clippings or links to evidence or stories about the student’s work, if available.
• In addition to the information in the form, send 2 letters of recommendation, each not less than 300 or more than 700 words each, describing the nominee’s work and why it is deserving of recognition and how the student’s leadership qualities may further social justice work in the future.
• Note there are no restrictions for how the Nominee uses the funds obtained through this award.
Your phone number
Are you the applicant or are you nominating someone else?
I'm the applicant
I'm nominating someone else
If you are nominating someone else, what is that person's name?
What is the date of birth of the nominated person?
What is the email address of the person you are nominating?
What is the home mailing address of the person you are nominating?
What is the phone number of the person you are nominating?
What is the nominee's race/ethnicity?
What is the school the nominee attends?
What is the student's year in school?
Why do you believe the nominee is deserving of the award? What future goals does the nominee have for pursuing social justice? (300 word limit)
APPLICATION support materials: please send the below materials to
using the message line: Black Education Matters Award
News clips or other evience of awardee commitment to anti-racism in education
2 letters of recommendation (you can provide one yourself)
Past "Black Education Matters Student Activist Award" winners:
The first three awardees in 2016 were:
Marci Owens has been fighting for universal healthcare since the age of 7, when her mom died from a treatable condition. She helps organize for Black Lives Matter and transgender rights.
Ahlaam Ibraahim hosts an annual anti-Islamophobia event to educate people who may be afraid of Muslims due to media bias.
Ifrah Abshir helped lead the Transportation Justice Movement for Orca Cards (fare cards for buses and trains in the Puget Sound area) in Seattle Public Schools. The two-year battle culminated in the city providing Orca Cards to low-income high school students throughout Seattle.
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Terms of Service