Educator of the Year Nomination Form

2016

Please nominate one K‐12 teacher for CHADD's Educator of the Year award.

The award winner receives:

1 complimentary registration to CHADD's International Conference on ADHD
Recognition plaque presented by the president of CHADD
Acknowledgement at a conference plenary session
A photo and bio placed on the CHADD website
A poster with photo and bio displayed at the conference

Base your nomination on teaching excellence and creativity which benefits students with ADHD. Nominations are due Friday, September 20, 2016. The award recipient will be notified by October 1, 2016.

Question Title

* 1. Teacher's Contact Information:

Teacher's Name

School Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Teacher's Email Address

Teacher's Phone Number

Question Title

* 2. My Contact Information:

Name

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

Email Address

Phone Number

Question Title

* 3. I am a:

School Employee

Student

Parent

Relative/Friend