KPRi’s Teacher’s Make A Difference Nomination Form:

(To comply with Federal Guidelines, we ask that you have a parent or legal guardian fill out and submit this nomination if you are 17 years or younger). 

Your Name: _______________________________________

Your Email: _______________________________________

Your Phone: ______________________________________

Parent’s Name (if under 18)___________________________

Teacher’s Name: ___________________________________

School: __________________________________________

Describe the person and tell us how or why they have had a favorable and lasting influence in your life?

 Please note that all submissions become the property of KPRi 102.1 FM