Nominate a Scholar

Please fill out the following information and press the SUBMIT button. Nominees must be members of their high school class of 2010. This form is to be filled out by teachers, principals, counselors, or other non-family member adults.

[If you are a student and wish to nominate yourself, please use this form instead.]

For more information call the Golden Apple Foundation at 312/407-0006 x105. Fields marked by * are required. Deadline: December 1, 2009.

	About the Student You are Nominating:
*	First Name:
*	Last Name:
*	Graduation Date:

	Student's School Information
*	School Name:
*	School Address:
*	City:
*	State:
*	Zip Code:
*	School Phone Number:	- -
*	School County

	Student's Home Information
*	Home Address:
*	City:
*	State:
*	Zip Code:
*	Email Address:
*	Phone Number:	- -

	About You
*	First Name:
*	Last Name:
*	Address:
*	City:
*	State:
*	Zip Code:
*	Email Address:
*	Phone Number:	- -
	Your relationship to the student:
	Your relationship to the student:
	How did you hear about the Golden Apple Scholars program?
	How did you hear about the Golden Apple Scholars program?