Nomination Form
Nominee's First Name:
Nominee's Last Name:
Nominee's CPS Title
Nominee's CPS Address:
City:
State:
Zip
Nominee's Email:
Nominee's Phone number:
Nominator's First Name:
Nominator's Last Name:
Nominator's Address:
City:
State:
Zip
Nominator's Email:
Nominator's Phone number:
On a separate document, please identify the leadership qualities and overall accomplishments of the nominee (1 ‐2 Pages Single Spaced, Times New Roman, 12 Pt Font). You may also include newspaper articles, published works, letters of support, or other evident of support.
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