Roseville SEPAC
Roseville City School District Special Education Parent Advisory Committee
Award Nomination

2010 Awards Nomination

Do you know an individual or organization that has made an extraordinary contribution to the lives of children receiving special education services? Examples may include but are not limited to:  exceptional teachers, administrators, community service organizations, parents, professionals (doctors, psychologists, occupational therapists, adaptive PE teachers, assistive technology personnel), etc.

 

Parents please make a nomination for our 2nd Annual Awards Dinner on Thursday, September 09, 2010.  The Special Education Parent Advisory Committee (SEPAC) will recognize individuals and organizations who are making a difference for children receiving Special Education Services..

 

To submit your nomination, complete the form below and submit.

 

Nominations due August 20, 2010

Nominee's Information
First Name:
Last Name:
Address Street 1:
Address Street 2:
City:
Zip Code: (5 digits)
State:
Daytime Phone:
Evening Phone:
Email:

Please provide the following information:

1. A brief description of the nominee's activities that contribute to the benefit of children receiving special education services.



2. Any additional, relevant information about the nominee (e.g. memberships, philanthropic affiliations, recognitions, awards received, overcoming significant challenges, etc.)

  

Nominator Information

First Name

*

Last Name

*

Street Address

*


City

*

State

*

Zip Code

*

Phone #

*

E-mail Address

Relationship to nominee

*

Questions?

Please contact Karl Dyer, Nominations Committee Chair
Cell: 916/871-3667
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