Bishop Herrmann Service Award 2017 Nomination Form Return by FRIDAY, MAY 5, 2017
To:
Lynn Altomari
[email protected] Office of Catholic Schools 197 E. Gay Street Columbus, OH 43215
(Click in each field to complete.) Student’s Name: Gender:
Male
Female
School Name: Principal’s Name: School Address: City/State/ZIP: School Phone: Student’s Address: City/State/ZIP: Elementary School Attended: Parish Affiliation: Father or Guardian’s Name: Mother or Guardian’s Name: Names and ages of brothers and sisters:
Bishop Herrmann Service Award 2017 Nomination Form Page Two College and career plans: (If possible, please be specific about which college or university you plan to attend in the fall).
On a separate, typed sheet, please list community organizations and projects in which student has participated as well as any honors received.
Principal or designee’s signature:
Please e-mail a digital photo (head and shoulders) in .jpg format to
[email protected]. NO HARD COPIES.
