form 2.docx · web viewparent/guardian contact info: click here to enter text. please provide a...
TRANSCRIPT
Protecting Children is Everyone’s Business
Communities throughout Iowa that share decision making, facilitate policy & practice change, promote family team decision making and expand community networks
Date: Click here to enter a date.
Name of Person making Nomination: Click here to enter text. Contact Phone Number: Click here to enter text.
Name of Teen Nominated for 2015 CPPC Resiliency Rally: Click here to enter text.
Age of Nominee: Click here to enter text. Gender of Nominee: Click here to enter text.
Race of Nominee: Click here to enter text. School Attended: Click here to enter text.
Passions & Interests of Nominee:
Click here to enter text.
Name of Parent/Guardian of Nominee: Click here to enter text.
Parent/Guardian Contact Info: Click here to enter text.
Please provide a brief (~200 word) summary of what makes this nominee AMAZINGLY RESILIENT:
Click here to enter text.
As a reminder, please keep sensitive & private information confidential. All nominations MUST be made by 5:00pm, Friday October 16th. Please submit all nominations to Tommy Ross, Polk County Community Partnerships Coordinator, at: [email protected]. Contact Tommy at 515.577.8508 with questions. Thanks for your participation!
Polk County DecategorizationIowa Dept. of Human Services | Polk County – River Place Office | 2309 Euclid Ave. | Des Moines, IA 50310 | 515-725-2729