LDA of Indiana State Award On-Line Nomination Form
Nominations for our Student of the Year Awards & College Scholarship Award are now being accepted.    
Before completing a Nomination or Letter of Recommendation, print and review the guidelines here.
Click here to submit a Letter of Recommendation.
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1)  Choose the Award Category:

2)  Students first and last name:
The student's "Primary" disability:
How can the student's disability be verified?:

Grade the student is in this school year (2009/2010):
Students age:
Name of the student's current school:
Principals name:
Name of the School District or Corporation:

Students home address, city and zip code:
Home phone with area code:
Name of Parent(s):

If the student will be going to or is already attending a college,
please complete the following information.
Has the student received an acceptance letter to attend
college during the 2009/2010 school year?  
Name of the College or University:
 
3)  Your first and last name:
Your Title: or Position:
Your relationship to the student:
Home phone with area code:
Work phone with area code:
Email address:  
Home address, city and zip code:

Tell us why you think this student should receive our Student of the Year or College Scholarship Award by answering the
questions below to help us “see” the student’s life at school, at home and their community.
You can "Copy and Paste" the information from you computer and insert below.
1)  Describe in 250 words or less the types of challenges the student faces living with LD or ADHD.

2)  Describe in 500 words or less how the student demonstrates academic perseverance, positive attitude, integrity,
self-advocacy skills, etc., and how he/she serves as a role model/inspiration to you or other students/adults in his/her life.

3)  Describe in 100 words or less the student’s aspirations for his/her future academic, career and life goals.

Briefly List any Personal Student  Merits.  

A)  Extracurricular Activities  (athletics, organizations, hobbies, clubs, plays, 4-H, etc.)
B)  Special Talents  (artist, writer, actor, singer, ability to encourage / inspire others, etc.)
C)  Community/School Involvement (academic / non-academic certificates / awards, leadership roles, volunteer / charity work, etc.)
D)  Work or Employment  (babysitting, mowing grass, or any other type of paid employment or work experiences, etc.)
 

Thank you for completing this on-line nomination form.
If your nominee is selected, we will notify you by email.  Award winners will be sent a letter by postal mail.
All nominations not selected will receive an acknowledgement card.

Please review the information before you click on the Submit Bar to send in your nomination.
You'll receive an email notice from us in a day or two to confirm we received the nomination.
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