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* 1. Nominator’s First Name: 

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* 2. Nominator’s Last Name:       

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* 3. Nominator’s Maiden Name:

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* 4. Nominator’s Email:   

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* 5. Nominator’s Phone:

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* 6. Nominee’s First Name:

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* 7. Nominee’s Last Name:

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* 8. Nominee’s Maiden Name:

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* 9. Nominee’s Class Year:

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* 10. Nominee’s Current Street Address:

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* 11. Nominee’s Current City:

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* 12. Nominee’s Current State:

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* 13. Nominee’s Current Zip Code:

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* 14. Please give a brief overview of the exceptional accomplishments in the nominee’s chosen field (i.e., military, business, technology, education, agriculture, the arts, or other worthy endeavors). Include position, major accomplishments (i.e., publications, patents, artworks, research), and recognitions (i.e., awards, medals, commendations). [200 word limit]

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* 15. Please provide a summary of the significant contributions made to society and/or Cumberland County Public Schools by the nominee. Include any activities leading to the betterment of others, such as volunteer work, missionary work, or participation in civic organizations (i.e., Ruritans, VFW, Lions Club, scout leader). [200 word limit]

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* 16. Please describe any demonstrated service in local, state, or national affairs. Activities could include lobbying, serving on local/state/or national advisory boards, or being a member of National Guard. [200 word limit]

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* 17. Describe the characteristics of the nominee that would make him/her an outstanding role model for future students. Include information such as participation in athletics and community events as well as hobbies, demonstrated work ethic, and occasions when nominee displayed great empathy or overcame great obstacles. [200 word limit]

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