Decatur Public Schools Foundation

The Decatur Public Schools Foundation Outstanding Alumni Award Nomination Form

Nominee’s attendance at the November 2015 CELEBRATE! The Legacy of Learning is a condition for winning the award. Please print or type and return completed nomination form to:

Decatur Public Schools Foundation ATTN: Zach Shields, Executive Director 101 W. Cerro Gordo Street, Decatur, IL 62523

Nominations are due by September 1, 2015. You may expand this form to create additional room. Attach any print media or additional supporting documents and include with application. You may also provide a link to online video or news articles.

Nominee’s Name: Address: City: State: Zip: Phone number: email: Graduate of (High School) – Year: Number of years nominee attended Decatur Public Schools: Employment: City: State: Post Graduate Education/Training:

1. Please list the nominee’s significant contributions/accomplishments in any of the following areas: the arts, science and technology, schools and community, academic enrichment, or the nominee’s field of work.

2. Describe the nominee’s community involvement or public service. 3. Explain how the nominee is a role model for others:

4. Has the nominee demonstrated a commitment to life-long learning? If so, how?

5. Please provide any additional information about the nominee:

If you request that we do so, nominees will be notified of this submission. Award winners will be honored at the Celebrate! The Legacy of Learning awards dinner in November 2015 and we ask that the nominator attend as well, if possible, to introduce the winner.

Nominator’s Name: Address: City: State: Zip: Phone number: email:

Signature: Date:

Direct questions about CELEBRATE! The Legacy of Learning awards nominations to:

Zach Shields - Decatur Public Schools Foundation - (217) 424-3300 or [email protected]