RIAHPERD Awards Nomination Form
Award (Check One)
Health Educator of the Year
Teacher of the Year - Physical Education Elementary Middle Secondary A. P. E.
Dance Educator of the Year
Recreation RecognitionHonor Award
Meritorious Service
I am nominating:
Name
Work Address
Home Address
Home phone Work phone
Nominated by
Address
Phone (H)
(W)Directions for submitting this form: 1. You can print this form out and mail it through the U.S. Postal Service to the address below, or 2. You can highlight, copy and paste it into a Word document and send it as an attachment to Dr. Cathy Moffitt at cgmof@hotmail.com.
Return this form no later than January 15, 2012 to:
Cathy Moffitt Email: cgmof@hotmail.com, or
183B Gravely Hill Road, Wakefield, RI 02879