Wayne Parker Advocate of the Year Award Nomination Form

Wayne Parker Advocate of the Year Award Nomination Form

This award is given each year to a person who has exemplified using information to assist their own child or someone else’s child with a disability to receive a free appropriate public education. STEP seeks recipients who demonstrate teamwork and collaboration and the zeal to share the information they have learned with others. Nominees may be a parent of a child with a disability, an advocate that works with families, a teacher who has been exemplary in the life of a student with a disability, or a service provider who has bridged the gap for a student or their family to assist in receiving a free appropriate public education.

All nominees will be considered and the recipient chosen to receive the award will be contacted for further information.

Please submit via email a photo of the nominee (jpg format) to information@tnstep.org.

Question Title

* 1. Submitted:

Date:

Date

Question Title

* 2. Information on Nominee:

Name of Nominee

Address

City

State

ZIP

Email Address

Phone Number

Question Title

* 3. County:

Question Title

* 4. Please check one:

Parent

Professional

Question Title

* 5. Role in the Student’s Life (Example: parent, caregiver, advocate, teacher, service provider, etc.):

Question Title

* 6. Please type a short essay describing why this nominee is deserving of the recognition. (Please Note: Do not give confidential information about the student unless permission has been given from nominee. Use broad terms such as: has a young child, middle school age child, etc., from East, Middle, or West TN.)

Question Title

* 7. Nominated by:

Name

Company

Address

City

State

ZIP

Email Address

Phone Number