Aliorum De Award-Nomination Form
Due by March 15, 2019. You must complete this form in its entirety before submitting.
Name of nominee *
Your answer
Category *
Nominee's grade, position, or role within the LPSD community: *
Your answer
Name of nominee's school *
Name of nominees's supervisor or teacher (if applicable)
Your answer
Nominated by: *
Please provide YOUR name for any questions and for an invitation to the celebration.
Your answer
Your phone number: *
Please provide your phone number so we can contact you. Include your area code.
Your answer
Your address:
Your answer
Are you a: *
In 400 words or less, please describe how you believe this person has made a difference in the life of a student with a disability. Tell a story with specific details describing why this person should be chosen as an Aliorum De Award recipient. For example, stories may include but are not limited to examples around what he or she does to support inclusion or authentic friendship, to ease daily transitions, or to support the unique learning environment of a student with a disability. In addition, please summarize your nomination by stating in one sentence why you feel that the nominee deserves this award. *
You may type your answer or copy and paste in the space below.
Your answer
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