NIAGARA CATHOLIC DISTRICT SCHOOL BOARD
THE NIAGARA CATHOLIC EDUCATION AWARD OF DISTINCTION NOMINATION FORM
FOR THE YEAR
This information is being collected pursuant to the provisions of the Municipal Freedom of Information and Protection of Privacy Act and under the Authority of The Education Act.,and will be used to identify nominees for The Niagara Catholic Education Award of Distinction. Questions about this collection should be directed to Frank Iannantuono, Superintendent of Education,
Niagara Catholic District School Board, 427 Rice Road, Welland, Ontario, L3C 7C1 905-735-0240
NOMINEE | ||||
FIRST NAME | LAST NAME | |||
| GROUP NAME (if applicable) | STREET ADDRESS | |||
| CITY | POSTAL CODE | |||
| TELEPHONE | ||||
NOMINATED BY | |||
FULL NAME | |||
| PHONE NUMBER | ADDRESS | ||
| SIGNATURE |
| ||
ENDORSED BY
FULL NAME
PHONE NUMBER
1
ADDRESS
SIGNATURE
FULL NAME PHONE NUMBER
2
ADDRESS
SIGNATURE
FULL NAME PHONE NUMBER
3
ADDRESS
SIGNATURE
DATE OF SUBMISSION
TO BE FORWARDED TO THE MANAGER OF BOARD SERVICES AND COMMUNICATIONS NO LATER THAN NOVEMBER 30th
OCTOBER 2012
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CONTRIBUTION TO CATHOLIC EDUCATION FORM (not to exceed one page)
DATE RECEIVED: ----------------- RECEIVED BY : ------------------
