Urban Education Activist Award Nominee InformationPlease fill out all required fields.Nominee Name* First Last Nominee Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Nominee Home Phone*Nominee Cell Phone*Nominee Work Phone*Nominee Personal Email* Nominee Local Association* Nominee County Association* Nominator InformationPlease fill out all required fieldsNominator Name* First Last Nominator Address* Street Address Address Line 2 City AlabamaAlaskaAmerican SamoaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaGuamHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaNorthern Mariana IslandsOhioOklahomaOregonPennsylvaniaPuerto RicoRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahU.S. Virgin IslandsVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Nominator Home Phone*Nominator Cell Phone*Nominator Work Phone*Nominator Personal Email* Nominator Local Association* Nominator County Association* Nominee Criteria Verification FormExplain how the nominee meets one or more of the following criteria:1. Initiated or engaged in activism that has had community-wide impact 2. Performs one or more of the following activities:a. Contributed to the motivation of individuals or groups seeking to become activists demonstrated by the testimony of those individuals and groups. b. Demonstrated creativity and innovation in the classroom and/or in parent/community engagement.b. Demonstrated creativity and innovation in the classroom and/or in parent/community engagement. c. Established an ongoing program or institution for the improvement of urban education and urban communities.c. Established an ongoing program or institution for the improvement of urban education and urban communities. 3. Successfully advocated for policy and structural changes that benefitted urban educational systems Upload Supporting Documents Drop files here or Select files Max. file size: 195 MB.
