Teacher/Student/Employee Nomination Form

Date

Name of Nominee

First NameLast Name

Nominee

Nominee Status

School/workplace in Chaves County

How do you know this nominee?

How long have you known this nominee?

Cancer Diagnosis

Date of Diagnosis (or estimated, if known)

Is this nominee currently receiving cancer treatment?

Type of cancer treatment

Describe to the best of your ability the nominee's personal story.

Share how this nominee impacts students/peers.

Provide any additional information about how the nominee supports the community, church, or other volunteer roles.

Is the nominee aware that he/she is being nominated?

Your Name

First NameLast Name

Your Phone Number

Your Email

Submit any printed forms to:

Roswell Independent School District

300 N. Kentucky, Roswell, NM 88201

All nomination forms must be submitted by April 1st or October 1st of each year for consideration.

ARM Foundation Nomination Form