Rep. Puri's Teacher and Small Business of the Month Nomination Form
Nominate a teacher or local small business you know to be Rep. Puri's next Teacher or Small Business of the Month and Rep. Puri just might surprise them with a visit, a certificate, and a shout-out for being an amazing member of our community!

If you have any questions or issues, please call us at (517) 373-0113 or email
Sign in to Google to save your progress. Learn more
Are you nominating a teacher or business? *
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy