Instructions: Print and complete this form.  Return with required materials described in the Nomination Guidelines 
Postmarked by January 30, 2010, to:
Friends of Education  c/o KNEA
715 SW 10^th St.  Topeka, KS 66612

Name of Nominee:________________________________________________________

Street Address:_______________________________________________________________

City:_____________________________________ Zip:_____________ Phone:____________

Specify Award Category:
_____ Community / Civic Organization
_____ Community Leader
_____ Partner Activity
_____ Private or Public Institution
_____ School Volunteer

Printed/typed name of person submitting nomination:_________________________________________________

Organization submitting nomination:_____________________________________________________

Street address:_______________________________________________________________

City:__________________________________ Zip:____________ Phone:________________

Chairperson:  Charles Volland, APR
Geary County Unified School Dist. 475
P.O. Box 370
Junction City, Kansas  66441
phone: 785-717-4066 / fax: 785-717-4003
charlesvolland@usd475.org