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Visionary Service Award Nomination Form

Contact Information for Nominating Party
School/Organization Affiliation:
Nominating Party's First Name:
Nominating Party's Last Name:
Nominating Party's Address:
City:
State:
Zip Code:
Nominating Party's Email Address:
Nominating Party's Phone Number:
Contact Information for Nominee
Nominee's First Name:
Nominee's Last Name:
Nominee's Address:
City:
State:
Zip Code:
Nominee's School/Organization Affiliation:
Nominee's Email Address:
Nominee's Phone Number:
Please answer the following questions:
What has the nominee done for your school?
How has the nominee's service provided an example for others?
What do you consider to be the long-term benefits of the nominee's contributions?
To what other organizations has the nominee shown exemplary service?
What other relevant information supports this nominee? (if a resume or curriculum vitae is available, please attach below)
If a resume or curriculum vitae is available, you may upload a copy of it here. File type is limited to PDF files only.

File Upload:
I understand that my nomination will be considered only after ADVIS receives a brief note endorsing the above nomination by my Head of School. Please have your Head of School reply with their endorsement of your nomination to barbarakb@advis.org
I agree
I am the HOS

As an added security measure, please enter the following text in the box below.
 

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