Global Deeds

The Global Deeds Civic Action Program

"*" indicates required fields

Nomination Form

Is your transportation to the State House secured to attend the Global Deeds Civic Action Summit in May?*

Yes

How many students are you bringing? (up to two depending on the district)*

Did you join our Slack Channel?*

Yes

Teacher’s Full Name*

Cell Phone*

School Name*

School’s Address*

Teacher’s Email Address*

Alt. Email Address*

School’s phone number (ext.):*

Guidance Counselor of Student*

Phone*

Enter your recommendation in the space provided

Student Nominee Information

Full Name*

Date of Birth:*

Grade*

Email Address*

Cell Phone Number*

Parent/Guardian’s Full Name*

Parent/Guardian’s Phone Number*

Email*

Address

Does the student qualify for free or discounted lunch?*

Yes

Student’s GPA*

Is the student an officer of Student Government?*

Yes

Enter the student’s essay explaining the kind of professional aspirations or civic engagement goals the student has and how this program/summit would help attain such goals.

List of the student's after school activities.