Education Champion Nomination Form 2019

Nominate an Education Champion!
Thank you for nominating a youth worker for School on Wheels' Education Champion Award! Please complete the form below to submit your nominee.
Your Name *

First Name Last Name
Your E-mail *
Your Phone Number *

- Area Code Phone Number
Before you nominate an individual, check all that apply to your nominee.

Works directly with Indiana youth in grades K-12 Has 5 or more years of experience with youth
Education Champion Nominees must meet all of the listed criteria to be considered as a candidate.

Nominee Information
Nominee's Name *

First Name Last Name
Nominee's Email *
Nominee's Phone Number *

- Area Code Phone Number
Nominee's Profession
Why are you nominating this individual for the Education Champion Award?
Up to 1,000 characters
How has the community been impacted by this individual?
Up to 1,000 characters
In what capacity have you worked with or seen the work of this individual?
Up to 1,000 characters
The nominee will be notified by email of your nomination when this form is submitted. The nominee will be asked to answer four questions as well as submit his or her resume. He or she will have until March 3rd to complete and submit their application to be considered for the 2019 Education Champion Award. The winner will be notified by March 20, 2019 and announced publicly April 18, 2019.

Nominate an Education Champion!