Human and Civil Rights Award Nomination Form - Maryland State Education Association

MSEA Human and Civil Rights Award Policy

Before beginning work on your nomination form, please take a moment to review MSEA’s Human and Civil Rights Award Policy and Guidance document. It will assist you in assuring that your nominee meets the award criteria and that your nomination form is submitted properly. It can be found by clicking HERE.

DEADLINE: 11:59pm on November 1 of the prior year in which the award is to be given. Late or incomplete nomination forms will NOT be considered.

Please complete this form to nominate a candidate for the MSEA Human and Civil Rights Award. In addition, you must include nomination forms from four (4) secondary nominators. The secondary nominator form can be found by clicking HERE. Note: Only current MSEA members are eligible to nominate a candidate. Nominators are required to provide their MSEA Member number.

After collecting the four (4) completed secondary nominator’s forms, please upload the completed documents to this nomination form in the space provided at the bottom of this nomination form.

The MSEA Human and Civil Rights Committee will review submitted nomination forms and will make recommendations to the MSEA Board of Directors for final approval. Please be sure to complete all required fields of the nomination form.

If you have questions, email [email protected] with “HCR Award Question” in the subject line.

Award Sought *

Name of Nominee *

First

Last

Nominee's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Nominee's Contact Number *

Nominee's Personal Email *

Nominee's Local Affiliate *

Name of Primary Nominator *

First

Last

MSEA ID #

If you do not know your MSEA member number, email [email protected] with “MSEA Member Number” in the subject line.

Primary Nominator's Address *

Address Line 1

Address Line 2

City

State

Zip Code

Primary Nominator's Contact Number *

Primary Nominator's Personal Email *

Primary Nominator's Local Affiliate *

Which of the following award criteria have been met by the nominee? Select all that apply. *

Describe specific examples of: actions taken by the nominee that promote and defend human and civil rights, activities promoting human and civil rights undertaken by the nominee that have a community-wide impact, ways in which the nominee has demonstrated leadership in the areas of human and civil rights activism, and/or the exceptional contributions the nominee has made/is making to education in Maryland in the area of human and civil rights. *

Minimum: 100 words; Maximum: 250 words.

I have read and understand MSEA’s Human and Civil Rights Award Policy.

As the primary nominator for this award, I understand that I am responsible for collecting and submitting all required elements for this nomination form, including supporting materials and secondary nominator forms (4 total, including nominators’ signatures), and that my failure to do so will result in my incomplete nomination form being rejected by MSEA’s Human and Civil Rights Committee.

I certify that I am a current member of MSEA.

Primary Nominator's Signature *

Clear Signature

Upload the four (4) required secondary nominator forms here. *

Click or drag files to this area to upload. You can upload up to 4 files.

Upload brief biographical sketch of nominee. *

Click or drag a file to this area to upload.

Upload nomination supporting materials

Click or drag a file to this area to upload.

Upload nomination supporting materials

Click or drag a file to this area to upload.

Upload nomination supporting materials

Click or drag a file to this area to upload.