Nominee's present position in the Nelson County Public School System: School ... 1368 Reas Ford Road ... 2017 Smyth Foun
2017 SMYTH FOUNDATION AWARD NOMINATION FORM Please type or print legibly on the FRONT side of this page ONLY. Individual Nominated: __________________________________________________ Nominee’s present position in the Nelson County Public School System: School: _______________________________________________________________ If a teacher, Grade or Specialty: ___________________________________________ If a staff member, please put an “X” after the appropriate position: Maintenance _____ Secretary/Bookkeeper _____ Bus Driver _____ Food Service _____ Custodian _____ Instructional Assistant _____ What is outstanding about this person's work? If you are nominating yourself, explain why you believe you should receive an award.
Do you personally know this individual? If so, in what way?
Nominated by: ______________________________________ Date: ___________________ Mailing Address: _______________________________________________________________ Mail Nomination to:
Smyth Foundation Awards 1368 Reas Ford Road Earlysville, VA 22936
Nomination Form must be postmarked by Friday, April 14, 2017. Late forms will not be considered! Awards will be presented in August at the All Day County Meeting
