NOMINATION FORM 6th Annual Greater Hartford

TELLING OUR STORIES / MAKING A DIFFERENCE
NOMINATION FORM
6th Annual
Greater Hartford
STARS
Student/Teacher
Achievement Recognition
Salute
Thursday, April 9, 2015
Hartford Public Library
Center for Contemporary Culture
500 Main Street, Hartford
5:30 - 7:30pm
Light refreshments: 5:30 pm / Program: 6-7 pm / Networking: 7-7:30 pm
Free parking available behind the library in the Sheldon Street parking lot.
For more information, contact David Hendricks (860) 707-6585,
Leonie Parks (860) 922-0080 or Estela Morales (860) 543-2107
 Your program may nominate TWO learners/former learners. You may
choose students that have shown strong academic achievements, played a
leadership role with their classmates or in your program, or both!
 Your program may nominate ONLY ONE teacher/staff member (Please
choose one teacher/staff to represent your program).
--------------------------------------------------------------------------------------------------------------------Return this form via email to Dana Little at [email protected] by Friday, March 13, 2015.
These descriptions will be included in a program booklet to be given out at the event.
If there are questions, please contact Dana Little via email or at (860) 524-4054.
Program Name: ________________________________________________________
Program Address: _____________________________________________________
Contact Name: ________________________________________________________
Phone: (_____)_____________ Email: _____________________________________
a. Adult Learner (s) to be honored (please write no more than 100 words about
why this learner is being honored):
b. Teacher/Staff member to be honored (please write no more than 100 words
about why this teacher/staff is being honored):
Note: If the learner and teacher/staff selected have a special relationship, please
feel free to write about that as well.