Thelma Pett Grant
Nomination Instructions
1. Complete this nomination form. Support letters from principals, staff members or professors should
be included.
2. The person making the nomination will address the following questions in a letter to the
committee:
a. Describe the nominee’s present position and previous positions within your school system.
b. What is the need for this nominee to further his/her education? Is financial assistance
justified?
c. What are the reasons for recommending this nominee?
d. Further comments
e. Send nomination letters with application letter
3. The applicant should answer the following questions in an attachment:
a. Do you belong to any educational organizations? If so, please indicate which ones. If you have
served as an officer in any one of these, please indicate.
b. How do you believe this award could benefit you?
c. What institution do you wish to attend? Do you have a second choice or another one that you
could attend?
d. How did you learn about the award?
e. Give a brief summary of your experiences and your present job description.
f. Must include 2 pictures to be sent to local newspaper, Conference Program and The Colorado
Communicator. (School picture is acceptable.)
Name
Your answer
Address
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City/State/Zip
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Telephone Number (home and work)
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Email Address
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CCIRA Membership # (Madatory Membership by October 15)
Your answer
Nominator's Name
Your answer
Nominator's Position
Your answer
Local Newspaper Name
Your answer
Local Newspaper Address
Your answer
Local Newspaper City/State/Zip
Your answer
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