Newton R. Disney Service Award Nominations

Newton R. Disney Service Award Nomination Form

We are pleased to announce the Newton R. Disney Service Award. This award is given to an individual who by his or her actions and dedication to the mission of Church Farm School has served the school and its students in a significant and committed manner. This individual would have provided the service humbly and to the best of their ability without expectation of recognition or reward but with only the wish that in some way they might give back and make a difference in the life of a young man. Nominations close on April 1 and the Award will be presented at the Alumni Dinner. Questions? Contact Lori McDermott at lmcdermott@gocfs.net.

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* 1. Nominator Information (Your Name):

Full name

Address, including zip code

Home phone

Cell phone

Email

Relationship to nominee

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* 2. Nominee Information

Full name

Address, including zip code

Home phone

Cell phone

Email address

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* 3. Background Information: Please provide information on the nominee’s personal life, such as family, education, interests and anything else of relevance. (300 words maximum).

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* 4. Reasons for Nomination: Please describe how this candidate has made a positive contribution to the mission and students of Church Farm School (500 words maximum).