Exit this survey Louis E. Yavner Award Application Question Title * 1. Type of Nomination Teaching Award Community Award Question Title * 2. Name of Candidate Question Title * 3. Title or Position Question Title * 4. For Teaching Award, please complete the following: Name of School School District School Address (Street) City/Town Zip Question Title * 5. Home Address Street City/Town State Zip Question Title * 6. Phone number Question Title * 7. Email address: Question Title * 8. Name of Nominator Question Title * 9. Title or Position Question Title * 10. Address Organization (if applicable) Street City/Town State Zip Question Title * 11. Phone number Question Title * 12. Email address Question Title * 13. Reference or Supporter Name Question Title * 14. Telephone number Question Title * 15. Email Address Question Title * 16. Reference or Supporter Name Question Title * 17. Telephone number Question Title * 18. Email Address Question Title * 19. By submitting this questionnaire, you acknowledge that you personally know the candidate and will submit letter of nomination electronically to EMSCURRIC@MAIL.NYSED.GOV by December 15. Yes, I acknowledge Comment(s) if any Done