USD #436 FACULTY HONOR PLAQUE APPLICATION

USD #436 FACULTY HONOR PLAQUE APPLICATION

This application can be for yourself, colleague, family member or friend. Payment of $100 is due before the plaque will be completed. Payment can be completed with this application or separately, as shown at the end of the form.
Information about Payee/Sponsor
Payee/Sponsor's Name (as it will appear on the plaque)*
Payee/Sponsor's Email
example@example.com
I would like the plaque to be presented at a special time and/or place. Here is my request:
If no presentation is requested, do we simply hang the plaque in the Little White Schoolhouse?

yesOther
Name of plaque recipient:
Present address, if living:
If deceased, date of death:

MonthDayYear
Date
If deceased, location of burial:
What years did the recipient teach or work for the Caney School District?
What subjects did they teach or what job did they perform?
Did they coach any activity? Sponsor any group? Belong to any educational organization?
Graduated from high school where and when:
Graduated from college(s)where and when:
Before coming to Caney, taught or worked where and for approximately what years?
After leaving Caney, taught and worked where and for approximately what years?
Spouse and children information:
Leisure time activities or hobbies of recipient:
Favorite subject(s) to teach or some favorite aspect of career:
Any special comments or recollections about their working career, particularly when employed by Caney school district.
Checks for $100 can be mailed to:
Caney Valley Historical Society
PO Box 212
Caney, KS 67333

Payment will also be accepted at the Historical Museum during business hours and can be completed in person or by phone. Payment can be made with a credit card, PayPal or using the Venmo QR code below.
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Teacher PlaqueOnline processing fee +$5.00
$105.00 Quantity

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USD #436 FACULTY HONOR PLAQUE APPLICATION

Information about Payee/Sponsor