Classroom Champions Nomination Form

 

 

1.Student Information
Student's First Name*
Student's Last Name*
Grade*
School*
School Phone Number*
School Principal
School Counselor
2.Contact Information
Your First Name*
Your Last Name*
Relationship to Student*
Your Street Address*
City*
State*
Zip*
Your Daytime Phone Number*
Your Evening Phone Number*
3.The purpose of having Classroom Champions is to recognize high school seniors who, not only do well on the field or court, but also do well in the classroom. Please tell us why this student should be recognized as a Classroom Champion. The following information should be included: class rank and GPA; sports they are involved with; awards received; extracurricular activities including community activities; academic achievements including scholarships; any other information you believe will help the Classroom Champions committee in their decision. *
4.Please enter your date of birth.
Month* Day* Year*
5.Terms and Conditions
   YES, I have read, understand, and agree to the Web site usage agreement and privacy policy.
* represents required fields
Children under the age of 13 may not submit this form.