BRAVO NOMINATION FORM

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Th e c o mp l e t e a p p l i c a t i o n c a n b e d o wn l o a d e d a t h t t p : / / w w w . mu s i c c e n t e r . o r g / e d u c a t i o n / b r a v o _ f o r m s . h t ml B RAVO NO MINA T IO N F O RM ONLY ONE NOMINATION FROM AN INDIVIDUAL SCHOOL IS ALLOWED, REGARDLESS OF CATEGORY. Are you nominating  a teacher OR  a school? Check only ONE. In what category are you nominating this candidate? Check only ONE.  Category #1: General Education Teacher BRAVO Award  Category #2: Arts Specialist Teacher BRAVO Award – (circle one) Dance, Music, Theatre, Visual Art  Category #3: Overall School BRAVO Award – Exemplary programs in all four arts disciplines NEW! School Program BRAVO AWARD *Note: Secondary School Program Award: More than one teacher teaches the subject and the school has more than one class offering in that discipline. Elementary School Program Award: Every student has access to the art form at least one period, weekly and can progress from one level to the next. (Circle one or more) Dance, Music, Theatre, Visual Art PLEASE COMPLETE ALL FIELDS below and WRITE CLEARLY Incomplete forms will result in delayed nominations. Nominee’s Name (if School Nominee, put school name) __________________________________________________________ Grade Level(s) Taught____________________________________Subject(s)______________________________________ School Name__________________________________________________Principal_________________________________ Please include school level, e.g. K-5, K-8, 6-8, 9-12, etc. School District (If Private school, write Private)__________________________ Superintendent______________________________ County _______________LA County Supervisor (Important. EVERY address in LA has a County Supervisor)______________________________ Los Angeles County is divided into supervisorial districts. Please go to http://bos.co.la.ca.us/district to find the County Supervisor and supervisorial district for your school. School Address_________________________________________________________________________________________ City___________________________________________________________State___________Zip______________________ School Phone _________________________________Ext. ________ School Fax_____________________________________ Nominee’s Home Address (very important)____________________________________________________________________ If this is a school nomination, put the principal’s home information. City__________________________________State_______Zip_____________Email__________________________________ Home Phone (very important) _________________________________ Cell Phone____________________________________ Nominated by__________________________________________ Signature__________________________________________ Title/Affiliation________________________________________ Phone_____________________________________________ Please write a few sentences detailing why you nominated this candidate: _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ _______________________________________________________________________________________________________ Mail or fax this form by October 2, 2009 to: The BRAVO Award 135 North Grand Avenue Los Angeles, CA 90012 Fax (213) 972-3174 www.musiccenter.org/education/bravo.html For more information call Faith Davis 213-972-3387

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