Information About the Nominee

Full Name:

Position:

Institution/Organization:

Is the Nominating official or his/her Institution an NCEA Member?
YES NO

Street Address:

Street Address (cont.)

City:

State:

ZIP Code:

Office phone:

Fax:

Home phone:

E-mail:

In your judgment, what is the most significant contribution the nominee has made to Catholic secondary education? (This should be approx. 200-300 words long and will be used as the basis for a description of the nominee's accomplishments if they are selected for an award.)

List any other local, (arch)diocesan, state, or national recognitions/contributions to Catholic secondary education:
 

What is the nominee's specific association with/service to/contribution to NCEA?

Please describe the nominee's educational background.

Please identify the nominee's current and recent professional affiliations.

If chosen, will the nominee be present at the 2013 Convention in Houston April 2-4, 2013?

YES NO

Any additional comments regarding this nomination:

Please list three professional references. (Ordinarily the list should include the chief administrator for the nominee's school, (arch)diocese, or religious community. Please include Name/Address/Telephone information for each reference.

Reference 1

Reference 2

Reference 3

Person submitting the nomination

Full Name

Position:

Institution/Organization:

Street Address:

Street Address (cont.)

City:

State:

ZIP Code:

Office phone:

FAX:

Home phone:

E-mail:

Date:

Awards Committee
NCEA Secondary Schools Department
1005 North Glebe Road, Ste. 525
Arlington, VA 22201

E-mail: secondary@ncea.org

Note: Please do not duplicate this online nomination with a printed/mailed or faxed version of the HTML based form.

Once submitted, the information on this form will be emailed to the Secondary Schools Department at NCEA.  A confirmation form will appear on your screen when the form has been submitted and you may print the confirmation for your records.  Thank you for your participation!