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The nominee is being nominated for the following award (choose one):*
Visionary in Education Award
Distinguished Service Award
Spirit of Education Award
Nominee
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M.I.
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Address 1
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Address 2
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Zip
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Nominator
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M.I.
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Address 1
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Address 2
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State
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Zip
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Phone (Home)
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Phone (Work)
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Nomination Date
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Nominee's qualifications or reason for induction
(one additional page may be attached to this form)
Letter of Recommendation
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