Time to Care About Education Nomination Form 1.Nominee's Contact Information Name of Nominee* Address* City* State* Zip* Daytime Phone* 2.Nominator's Contact Information Nominator's Name* Nominator's Phone* 3.What has the nominee done to impact the community?* 4.Is the nominee a student, teacher, or education administrator?* Student Teacher Education Administrator 5.What school does he/she work for or attend? * 6.Why should the nominee be selected as the Time To Care About Education Award Winner?* * represents required fields Children under the age of 13 may not submit this form.

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