Honoree's Name:

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* 1. Honoree's Name:

School or Department:

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* 2. School or Department:

Describe how the action of your honoree positively contributes to our District's climate:

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* 3. Describe how the action of your honoree positively contributes to our District's climate:

Nominated by:

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* 4. Nominated by:

I am a........

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* 5. I am a........

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