Prep for Prep Nomination Form
Nominator Info
Nominator and Student School Information
Are you a
guidance
counselor or a member of school personnel?
Yes
No
Nominator School Borough Name
Nominator School
Other School Name
Other School Street Adress & Zip Code
Are you nominating the student on behalf of a community organization?
Yes
No
If you are nominating on behalf of a community organization please enter the orngnaization name
Nominator First Name
Nominator Last Name
Nominator Title
Nominator Email
Nominator Phone Number
Nominator School ID
Nominee
Student Information
Student First Name
Student Middle Name
Student Last Name
Student School Borough Name
Student School
Other School Name
Other School Street Adress & Zip Code
Student Gender Identity
Student Birthdate
Student School ID
Student Test Details
Current Grade
GPA
Last year's standardized ELA exam score
Last year's standardized Math exam score
Other Standardized Test Name
Percentile/Score
Parent Legal Guardian Information
Parent/G
uardian
First Name
Parent/
Guardian
Last Name
Parent/Guardian Email
Parent/
Guardian
Phone
Parent/Guardian Preferred Language
Parent Legal Guardian Address
Street
City
State
Zip Code
Contact Information