New York State School Boards Association

2018 Champion for Change Award Nomination Form

Nomination DEADLINE IS March 16, 2018.
Guidelines for the 2018 NYSSBA Champion for Change Award

*= Required field

*Candidate First Name
*Candidate Last Name
*School District
*BOCES (District a component of which BOCES):
*Candidate Address
*Zip Code
*Candidate Phone Number
*Candidate Email
*Contact Name
*Contact Email
*Contact Phone Number
Contact, if more detailed information is required

*Board/BOCES Resolution:
Please key in the text to the board resolution nominating this candidate for the Champion for Change Award. See the sample board resolution in the Award Guidelines (link above).
*Start Date (Local NYSSBA Member School Board)
*End Date (Local NYSSBA Member School Board)
Start Date (BOCES)
End Date (BOCES)
NYSSBA Current Activities
NYSSBA Past Activities and Training (When/Where)

School Board Service and Activity

Describe briefly the leadership qualities the nominee has demonstrated during the years of school board service:

List the accomplishments, contributions and awards, including past nominations for the Champion for Change Award, that bear witness to the nominee’s effective service to school boards and the students in their school districts, and when they were received:
Include any other information that will strengthen the nomination

Please send three (3) letters of recommendation to . One must be from the school district's superintendent.

Before submitting this form, please click on the link below to move the contents of box "A" into box "B" leaving the first box empty.

A: B: Click to Move


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