DSA Nomination Bio Form 2012 by 1ut45Np

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									                                GEORGIA INDEPENDENT SCHOOL ASSOCIATION
                                     DISTINGUISHED SERVICE AWARD
                                          SUMMARY OF NOMINATIONS
Listed below are the names of all teachers, administrators, and other staff who have completed 25 years of service
in private, parochial schools or private colleges. The current school year may be included.

                     Do NOT include anyone who has previously received the Distinguished Service Award.


SCHOOL:


                  NAMES OF TEACHER / STAFF                                             POSITION or TITLE
                    (Full Name - Please Print)


1.


2.


3.


4.


5.


6.

ATTACHMENT: Please have the above NOMINEE(s) complete the attached ELIGIBILITY/BIOGRAPHY FORM and
return to the GISA Office on or before September 28, 2012. If you have more than one nominee, please PHOTOCOPY
the Eligibility/Biography Form to distribute to each of them.

NOTE: Since individually engraved plaques and other special recognition are to be given to each person who qualifies,
please return by the due date to allow necessary time to obtain personal data and to engrave plaques, etc.




                     Date                                                      Signature of School Head

Please Mail to:        GISA                                 ~or~    Fax to:    (706) 938-1401
                       Post Office Box 1057
                       Thomaston, GA 30286                          Email to: robin@gisaschools.org

                                                  THANK YOU!


                        DUE NO LATER THAN: Friday, September 28, 2012
                        DUE NO LATER THAN: Friday, September 28, 2012
                                      GISA DISTINGUISHED SERVICE AWARD
                             NOMINEE ELIGIBILITY & BIOGRAPHY FORM
ELIGIBILITY:
(1) Including the current school year, has 25 years of service in private education, including private college teaching;
(2) All vital positions in private education included;
(3) May be retired and not currently employed in private education;
(4) Has not received the GISA Distinguished Service Award previously.
                  AWARD PLAQUES will be delivered to Heads of School at Nov. 4 Business Meeting

   NAME OF NOMINEE:
            Please CLEARLY PRINT or TYPE your name exactly as you want it to be engraved on your DSA PLAQUE


    NAME OF SCHOOL:

                                 POSITIONS IN PRIVATE EDUCATION HELD BY NOMINEE:
       Position                                School & City                                                   Dates




                                     EMPLOYMENT OTHER THAN PRIVATE EDUCATION:
       Position                               School & City                                                    Dates




EDUCATION: Secondary School & Location:
NAME OF COLLEGE(S) GRADUATED FROM:


LIST DEGREE(S) EARNED:




                                  (THIS FORM MAY BE DUPLICATED AS NEEDED)

								
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