Nominee's first name

Nominee's last name

Nominee's address

Nominee's city

Nominee's zip code

Nominee's phone number

Nominee's email address

Add picture:  Picture must be .jpg file type, at least 72dpi, and 300 pixels wide.

Program areas

• Adult Basic Education
• Adults with Disabilities
• Career and Technical Education/Food Preparation
• Career and Technical Education/Health
• Career and Technical Education/Office
• Career and Technical Education/Other
• Career and Technical Education/Transportation
• Citizenship
• English as a Second Language
• High School Subjects and HSE
• Older Adults
• Parent Education/Family Literacy

Years of attendance

Goals your nominee met

Nominee's story This is your opportunity to tell the student's success story! Be specific and pay close attention to the rubric criteria. Most importantly, how did adult education contribute to the current success of the nominee? We are also interested in learning about the nominee's background, what they are doing now, and their plans for the future. Although there is no limitation, most stories are 300 to 500 words.

Directions: Please answer the following questions to the best of your ability to ensure that pertinent parts of the scoring rubric are taken into account. Feel free to cut and paste from your nominee’s story for written responses, if applicable.

Describe your student’s employment status. (Check all that apply.)

• Unemployed
• Part-time
• Full-time 
• Volunteer
• Providing care to medically fragile family member(s) 
• Providing care as a parent/guardian

Write specific details about how adult education supported the student in getting a job, a promotion, or increased wages.

Write about the positive contributions this student has made in the classroom, school, or broader community (e.g., children’s school, food banks, volunteering, community service, etc.). Provide specific examples beyond “they are a pleasure in class.”

Indicate which of these statements describe this student’s progress in adult education programs. (Check all that apply.)

• Just started and completed minimal work.
• Completed some course work. 
• Completed significant coursework in a specific program (e.g., Citizenship, ESL, ABE, HSE, AWD, CTE Certification Programs.) 
• Achieved a primary goal (eg., passed their GED/HiSET, Completed ESL levels, Citizenship).
• Completed their primary goal and are continuing on a career or secondary education pathway.

Write how adult education has directly improved this student’s and/or family’s lives (e.g., describe the connection, a direct link, and/or a cause/effect relationship between adult education and improvement in the person’s life).

Describe the personal, social, and/or economic challenges the student has had to overcome up to this point in their adult education journey.

Nominator's name

Nominator's title

Nominator's phone number

Nominator's email address

Nominating agency

Nominating agency's website

Administrator's name

Administrator's email address