Nominee Registration Form

NOMINEE REGISTRATION

NOMINATION FORM
Fill out with accurate to nominate for an award.

LIST OF NSIM AWARD CATEGORIES

Parent of the Year Award Child of the Year Award School of the Year Award Teacher of the Year Award Employee of the Year Award Leadership of the Year Award Special Merit Award
REASON FOR NOMINATION
Explain why your nominee deserves the selected award.

NOMINEE INFORMATION Nominee's Name

First Name Last Name
Nominee's Date of Birth
Nominee's Phone Number

Area Code Phone Number
Nominee's E-mail Address
Nominee's Address

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

3. NOMINATOR INFORMATION
Nominator's Name

First Name Last Name
Relation to Nominee, if any
Nominator's E-mail Address
Nominator's Phone Number

Area Code Phone Number
Nominator's Address

Street Address
Street Address Line 2
CityState / Province
Postal / Zip CodeCountry
Should be Empty: