SENIA Student Award Nomination Form
Name of Nominee:
Name of Nominator
Section 1. - Background Information
A. Describe in 150 words or less the challenges this student encountered prior to his or her current accomplishments (e.g., difficulty with reading).
B. Describe in 150 words or less the current type of special education services provided to the nominee (e.g., general education class with learning support, inclusion, special education classes).
Section 2. - Describe the student's accomplishments.
(Consider creativity, innovation, and significance of the student’s accomplishments to the individual and others.)
Describe the student’s accomplishments.
A. Describe in 150 words or less the student’s achievements and accomplishments in relation to advocacy and awareness of special education issues in your community. You can add appendices demonstrating examples of the student’s achievement.
B. Describe the setting in which the accomplishments occurred (i.e., home, school, community, work).
C. Describe in 150 words or less the impact of the student’s accomplishments on him- or herself and others.
If you are human, leave this field blank.
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