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Teacher Nomination Form
Directions: Teachers, please use this form to nominate students for Shodor Programs.

Student Information
Enter information about the student you are nominating.
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Name
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Address
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City
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State
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Zip
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Phone
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Name of Parent/Guardian
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Age
*
Sex
*
Grade student will enter in the current school year
(If you are a home school student, estimate an approximate grade level.)
Teacher Information
Enter your contact information.
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Name
*
Email
*
School Name
*
School Type
*
Phone
Nomination
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Please write a description of this student's demonstrated excellence in science, mathematics, and/or computing.
*
How did you hear about the program?:
(This is important to us, so please complete this field.)
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