LDAK Award Nomination Form

Learning Disabilities Association of Kansas

Awards Nomination Form

Please complete and mail to:
Sharyl Kennedy
4901 Reinhardt Drive
Roeland Park, KS 66205

I) Nominee:

Name _________________________________   Phone ____________/ ______________
                                                                                                Day                  Evening
Address _______________________________   City _________________ ZIP ________
Current Position __________________________Where? ___________________________ Email:___________________________________

II) Award:

______ Outstanding Special Education Teacher
______ Outstanding Professional
______ Outstanding Student
______ Swalwell Award for Parent of the Year

III) Qualifications:

Please describe the nominee's service to the Learning Disabled: ________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
In what way has the nominee's performance been outstanding and unusual? ______________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________
___________________________________________________________________________

IV) Nominator:

Name _____________________________ Phone ____________ / _____________
Day Evening
Position ____________________________E-Mail___________________________
Address ___________________________ City ______________ ZIP __________