HSLA: High School Representative Nomination Form

HIGH SCHOOL STUDENT SELECTION FORM
Student selections are open for Pennsylvania, New Jersey, and Delaware high school principals, administrators, and guidance counselors to recognize one high school student in their junior year from their school, who has demonstrated leadership by standing up for what is right, finding a way to address a wrong, or making a significant difference in their school or community. Please complete all sections of the form. Incomplete selection forms will require re-submission. Selections are due by Friday, November 15, 2024.

PRINCIPAL/ADMINISTRATOR/GUIDANCE COUNSELOR NAME*

First NameLast Name

JOB TITLE*

HIGH SCHOOL NAME*

SCHOOL PHONE #*

Please enter a valid phone number.

SCHOOL EMAIL ADDRESS*

example@example.com

PREFERRED NAME OF SELECTED STUDENT*

First NameLast Name

STUDENT EMAIL ADDRESS*

example@example.com

SELECTED STUDENT GRADUATION YEAR (of note: only current juniors are eligible for this award.)*