Nomination Form for Central Coast Section
Distinguished Service Award
Full Name of Nominee: ________________________________
Nomination submitted by: ______________________________ Date: ______________________
Address of Nominee: ________________________________________________________________
Telephone #: (Home): __________________________________ (Work): ____________________
 
A.    Central Coast Section Affiliation (circle one or more):
CCS Member School CCS League CIF Affiliate Community Group Media Related Assn (e.g. Officials, etc.)
Name of Group(s) circled above: ________________________________________
Address: ________________________________________ Telephone: ______________________
 
B. List of Significant Contributions of Individual (Attach additional sheets if necessary)
Date(s) Contribution
1. ___________________ ___________________________________________________________
2. ___________________ ___________________________________________________________
3. ___________________ ___________________________________________________________
4. ___________________ ___________________________________________________________
5. ___________________ ___________________________________________________________
 
C. List Other Related Awards, Honors and Recognition Received
Date(s) Award
1. ___________________ ___________________________________________________________
2. ___________________ ___________________________________________________________
3. ___________________ ___________________________________________________________
4. ___________________ ___________________________________________________________
5. ___________________ ___________________________________________________________
D.  Other descriptive Rationale and Statement from Sponsors for Nominee (additional pages may be attached if necessary)
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Signatures of CCS Individuals who Endorse this Candidate:

I (We) hereby recommend and endorse the above nominee for consideration of the CCS Distinguished Service Award:
__________________________________________________________
(Signature)
___________________________________________ _______________________________
(Type or Print Full Name) (Telephone)

I have known the nominee since ________ in the capacity(ies) of __________________
I (We) hereby recommend and endorse the above nominee for consideration of the CCS Distinguished Service Award:
__________________________________________________________
(Signature)
___________________________________________ _______________________________
(Type or Print Full Name) (Telephone)

I have known the nominee since ________ in the capacity(ies) of __________________
I (We) hereby recommend and endorse the above nominee for consideration of the CCS Distinguished Service Award:
__________________________________________________________
(Signature)
___________________________________________ _______________________________
(Type or Print Full Name) (Telephone)

I have known the nominee since ________ in the capacity(ies) of __________________

Please return this nomination to:

Central Coast Section/CIF
6830 Via Del Oro, Suite 103
San Jose, CA 95119
**** No Later than February 28th ****

Any questions, call CCS, (408) 224-2994