Individual and State Affiliate Awards Form

Which award category are you nominating for?(Required)

State Affiliate Information

State Affiliate Name(Required)

State Affiliate Representative's Name(Required)

Prefix First Last Suffix

State Affiliate Representative's Email(Required)

Service to the Community

(to be completed as applicable)

Community Association/Organization

Office Held/Awards Received

Date(s)

State Affiliate Board Makeup and Membership Details

State Information

State's School Enrollment

Students in State Receiving Free/Reduced Price Meals (%)

State School Demographic Composition

% American Indian/ Alaskan Native

% African-American/ Black

% Native Hawaiian/ Pacific Islander

% Asian

% Hispanic/Latino

% Caucasian/White

Nominee's Personal Information

Nominee's Full Name(Required)

Prefix First Last Suffix

Nominee's Personal Address(Required)

Street Address Address Line 2 City State ZIP Code

Nominee's Phone(Required)

Nominee's Email Address(Required)

Nominee's Professional Information

Nominee's current position (if applicable)(Required)

If not applicable, type N/A

Total number of years nominee has been in current position

(skip this question if they do have a current position)

Please enter a number greater than or equal to 0.

Professional Experience (list by most recent, exclude current position/school)

Click the (+) sign to add more experience

Position

Name and Locations of District/School

Dates

Professional Preparation (If applicable, list by most recent)

Click the (+) sign to add more rows

Degree

Name of Institution

Location of Institution

Dates

Professional Activities, Awards and Honors

(to be completed as applicable)

Professional Association/Organization

Office Held/Awards Received

Date

Service to the Community

(to be completed as applicable)

Community Association/Organization

Office Held/Awards Received

Date(s)

School District/School Information

To be completed as applicable

Name of School District / Name of School

School District Superintendent's Name

Prefix First Last Suffix

School Superintendent’s E-Mail Address

Superintendent/Board President's Phone

District Setting

Urban

Suburban

Rural

School District Enrollment

Students Receiving Free/Reduced Price Meals (%)

School District Demographic Composition

% American Indian/ Alaskan Native

% African-American/ Black

% Native Hawaiian/ Pacific Islander

% Asian

% Hispanic/Latino

% Caucasian/White

School’s Grade Level Configuration

(check one, if applicable)

Elementary / Middle School District: (includes either K-5 or K-8 may include PK)

High School District: (Grades 9-12 does NOT include Pre/ K-8)

K-12 School District (may include PK)

Three Most Significant Accomplishments

(may be submitted as separate attachments)

#1

#1 File Upload

Drop files here or

Max. file size: 100 MB.

#2

#2 File Upload

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Max. file size: 100 MB.

#3

#3 File Upload

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Max. file size: 100 MB.

ALAS 2025 Awards Nominations Form

State Affiliate Information

State Information

Nominee's Personal Information

Nominee's Professional Information

School District/School Information

Three Most Significant Accomplishments