Tavo Good Spirit Award

2009 Nomination for Scholarship Form
Name:
Agency:
Position:
Mailing Address:
City: State: Zip:
Phone Number: Fax Number:
Email:
 Length of Service to Agency:
 HISSC Member Since:


Please state any contributions the nominee has made to your agency and/or HISSC:
Please state why the nominee should receive the is award:
For Official Use Only.
Date Received:

Eligible nominations must be postmarked or received via email no later than August 1.

Please return this form:
Beverly Bewley, HISSC Secretary, PO Box 1025, Lamar, AR 72846 beverly.bewley@aspb.ar.gov

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