Dearborn Public Schools Impact Award 2015 Nomination Form Deadline for submitting nominations: April 24, 2015. Name of employee being nominated: ____________________________________________ (The nominee must have been employed by the Dearborn Public Schools for at least 3 years.) Work location of nominee: _____________________________________________________ Job title of nominee, if available: ________________________________________________ Name of person submitting nomination: __________________________________________ Please check all that apply regarding the person submitting the Impact award nomination. Secondary Student (please list school) _______________________________________ Parent District Staff Member (please list work location / job title): ______________________ Phone: _________________________________ Email: __________________________________ Nomination: In 250 words or less please describe how the Dearborn Public Schools staff member you are nominating: 1. Consistently demonstrates at least one of the Dearborn Public School District’s Core Values. 2. How through their work they create a better experience for students, families or colleagues in the Dearborn Public School District. 3. That they are consistently personable, professional and polite in the daily performance of their job. (Please use additional pages as needed.)
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