Utah FFA Blue & Gold Service Award

Utah FFA Blue & Gold Service Award
Instructions

Please fill out all information below. Please note that that the first question on the form will ask if you are nominating a teacher or another individual. Please be sure to select the correct choice. If you would like to submit a teacher as well as another individual in one form to save time, please select "both" and follow the instructions on each page. Due: January 15th by 11:45 pm
Please select which Nomination you are making*
Individual Making the Nomination*

First NameLast Name
Chapter Making the Nomination*
Name of Nominee (spelled exactly as it should appear on the award)*

First NameLast Name
Nominee's Complete Home Mailing Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Nominee's Email Address*
example@example.com
Nominee's Phone Number*

IF YOU ARE NOMINATING AN INDIVIDUAL OTHER THAN A TEACHER, PLEASE SKIP THIS SECTION AND PROCEED TO THE NEXT PAGE.

If you are nominating both a teacher and another individual, fill out the information below and then click "next" to complete both nominations. Click "submit" on the second page.
Agricultural Education Teacher Nomination

Continue with this form if you are nominating a current agricultural education teacher. Using numerical values, insert the correct number in each of the following 7 questions. The nominee's total score must be 40 or above to qualify.
How many total years has this individual served as an Agricultural Education Teacher?
How many times has the chapter advised by this individual received the Five Star Chapter Award?
How many times has this individual served as a state CDE/LDE Chair?
How many years has this individual been a member of UAAE?
How many years has this individual served as a UAAE Officer?
How many years has this individual served as an FFA Advisory Board Member?5.
How many years has this individual served as an FFA Area Chair?
Nominee's total score (add all scores above and input in box below)
Describe this individual's contributions to the Utah FFA Association and its members. Please write in a manner that will allow for this to be easily read at the award ceremony.

0/200
CLICK SUBMIT IF YOU ARE NOMINATING A TEACHER. IF YOU ARE NOMINATING SOMEONE ELSE, PLEASE CLICK "NEXT"

Nomination for Individual Other Than an Agricultural Education Teacher

Continue with this form if you are nominating an individual who is not a current agricultural education teacher. Using numerical values, insert the correct number in each of the following 5 questions. The nominee's total score must be 35 or above to qualify.
Enter a 5 in the box below if this individual has already received the Honorary Chapter FFA Degree from your chapter.
Enter a 5 in the box below if this individual has already received the Honorary State FFA Degree from the Utah FFA Association.
Enter the number of years this individual has provided service to your local chapter.
Enter the number of years this individual has provided service above the chapter level but below the state level.
Enter the number of years this individual has provided service at or above the state level.
Nominee's total score (add all scores above and input in box below)
Describe specifically this individual's contributions above the chapter level but below the state level. Please write in a manner that will allow for this to be easily read at the award ceremony.

0/100
Describe specifically this individual's contributions act or above the state level. Please write in a manner that will allow for this to be easily read at the award ceremony.

0/100
Should be Empty:

Instructions