BELLEVILLE HIGH SCHOOL DISTINGUISHED GRADUATE NOMINATION FORM

I would like to nominate                                           as a recipient of the Belleville High School Distinguished Graduate Award.  Please check here if candidate is deceased                      (If so, please complete “Special Posthumous Category” below)

Candidate’s Background:

Address:                                                                                                                                  

Telephone Number:                                                           Year of Graduation:            

eMail:__________________________________________________________________

(Note: Graduation date must be at least ten (10) years prior to current graduation year in order to qualify for Distinguished Graduate Award.)

Special Posthumous Category:

Year of Birth:                                        Year of Death:                                     

Year of Graduation:                             

(Note: Graduation date must be at least ten (10) years prior to current graduation year in order to qualify for Distinguished Graduate Award.)

Your Name:                                                           Signature:                                                      

Address:                                                                                                                                     

Telephone Number:                                                           

In your own words, briefly describe why you think this candidate should be considered for this award:

Please return to Superintendent’s Office, Van Buren Public Schools, 555 West Columbia Avenue, Belleville, MI 48111, no later than the second week in January.