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Wayne Parker Advocate of the Year Award Nomination Form
This award is given each year to a person who has exemplified using information to assist their own child or someone else’s child with a disability to receive a free appropriate public education. TNSTEP seeks recipients who demonstrate teamwork and collaboration and the zeal to share the information they have learned with others. Nominees may be a parent of a child with a disability, an advocate that works with families, a teacher who has been exemplary in the life of a student with a disability, or a service provider who has bridged the gap for a student or their family to assist in receiving a free appropriate public education. All nominees will be considered and the recipient chosen to receive the award will be contacted for further information.
Date
Nominees Name
*
First Name
Last Name
Nominees Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Nominees County
*
Nominees E-mail
*
Nominees Phone Number
*
-
Area Code
Phone Number
Nominees Cell Number
-
Area Code
Phone Number
Please check one:
*
Parent/ Guardian
Professional
Role in the Student’s Life:
*
(Example: parent, caregiver, advocate, teacher, service provider, etc.)
Short essay describing why this nominee is deserving of recognition.
*
Please Note: Do not give confidential information about the student unless permission has been given from nominee. Use broad terms such as: has a young child, middle school age child, etc., from East, Middle, or West TN.)
0/250
Include a photo of the nominee (jpg format)
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Nominated by:
First Name
Last Name
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Phone Number
-
Area Code
Phone Number
Email
example@example.com
CLICK HERE to submit your nomination
Should be Empty: