Nomination Form

When considering a nomination, ask yourself the following questions: Were the employee's actions above and beyond their regular responsibilities? Is there a specific example that can be included in the nomination? Did the actions by the employee take place on district/school grounds or part of a District sponsored event? Once completed, please select the “Submit” button at the bottom of this form.

1.	Date of Nomination:* Please enter the date of this nomination :
	mm/dd/yyyy

2.	Nominee Information: * Nominee Name:

3.	Nominee Location:*

4.	Reason for Nomination:* Please note this information will be used in employee recognition. Please give a detailed reason for the nomination of this person. Be sure to review the criteria above.

5.	Contact Information of Employee Submitting Nomination: Please enter your information below* Nominator Name:

6.	Nominator Location:*

7.	Nominator Phone:

8.	The employee's actions were above and beyond their regular responsibilities.*

EPIC Award