Cliff Boyce Nomination Form

CLIFF BOYCE NOMINATION FORM

You must be a member of WTSEA and certified by OSPI to teach in a public school program in order to
nominate someone or to be nominated for this award

* Indicates required field

Date *

Name of nominee *

First

Last

Phone Number *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Place of Employment *

Name of Agency / Commercial School if you have selected "Other" *

Email *

Number of years involved with TSE *

Major area of responsibility in TSE *

Please give an approximate number for each of the questions below in uncertain

For each item below give then number of years of service:

# of years in TSE classroom *

# of years behind the wheel *

# of years a member of WTSEA *

# of WTSEA conferences attended *

List any special techniques this nominee or materials this candidate has developed for use in Traffic Safety Education *

List the major considerations that make this nominee deserving of the award *

Please list any other reason that this nominee should receive the Cliff Boyce Award *

Person nominating ( to contact for any additional information) *