Nebraska Schoolmaster Club Nomination Form
This form is to be complete by current Nebraska Schoolmaster Club members.
What is the LAST NAME of the person you wish to nominate? *
Please enter the nominee's LAST name
Your answer
What is the FIRST NAME of the person you wish to nominate? *
Please enter the nominee's FIRST name
Your answer
What is the STREET ADDRESS of the nominee? *
Please enter the STREET ADDRESS of the nominee.
Your answer
What is the CITY OR TOWN where the nominee lives? *
Please enter the CITY or TOWN where the nominee lives.
Your answer
What is the STATE where the nominee lives? *
Please enter the STATE where the nominee lives.
Your answer
What is the ZIP CODE where the nominee lives? *
Please enter the ZIP CODE of the nominee.
Your answer
Where is the nominee currently employed? *
Please enter the NAME OF THE SCHOOL where the nominee is employed.
Your answer
IMPORTANT: What is a PERMANENT E-MAIL ADDRESS WHERE THE NOMINEE CAN BE REACHED? *
Please enter the PERMANENT E-MAIL ADDRESS of the nominee.
Your answer
IMPORTANT: What is an alternate E-MAIL ADDRESS WHERE THE NOMINEE CAN BE REACHED?
Please enter the alternate E-MAIL ADDRESS of the nominee (if any).
Your answer
IMPORTANT: What is a PERMANENT phone number we may use to contact the nominee?
Please enter the permanent phone number of the nominee (if any).
Your answer
Club Member making nomination: What is your LAST NAME *
Please enter your LAST NAME
Your answer
Club Member making nomination: What is your FIRST NAME *
Please enter your FIRST NAME
Your answer
IMPORTANT: What is a PERMANENT E-MAIL ADDRESS where you can be reached? *
Please enter the PERMANENT E-MAIL ADDRESS where you can be reached.
Your answer
IMPORTANT: What is a phone number where you can be reached? *
Please enter a phone number where you can be reached.
Your answer
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