MARGARET NICHOLSON DISTINGUISHED SERVICE AWARD
NOMINATION FORM

NOMINATION PROCEDURE
In addition to completing the form below, the contributions of each nominee should be substantiated in one or more letters of support, submitted by the nominator or nominating chapter, which describes specific examples of service, leadership, and commitment. Both the nominator and the nominee must be CSTA members for a minimum of four years. The winner of the award will be selected by the CSTA Board of Directors from a slate of nominees submitted by the CSTA Awards Committee. Awards will be presented at the California Science Education Conference sponsored by CSTA.

Nomination deadline: May 15, 2012

Name of Nominee:

Nominee Mailing Address:

Nominee Phone Number:

Nominee Email Address:

Nominated by (your name):

Your Mailing Address:

Your Phone Number:

Your Email Address: