Solano County SELPA Community Advisory Committee 2019-2020 Annual Recognition Award Nomination Form

Solano County SELPA Community Advisory Committee (CAC) celebrates the 14th Annual Awards Ceremony!

At this May 4, 2020 celebration, the CAC will recognize nominees including students, school district staff and community members!

One student, one community member and one individual from each member district in the Solano SELPA, which includes Benicia, Dixon, Fairfield-Suisun, Travis, and Vacaville Unified School Districts and the Solano County Office of Education will be recognized for their exemplary service and commitment to students with disabilities and the broader special education community!

Nominations for the 14th Annual Community Advisory are due no later than February 17, 2020. No late nominations will be accepted.

Date of Submission​​
First Name​
Last Name​
Position of Nominee​
School District, Agency or Organization of Nominee​
Nominee's School Site or Work Location​​​

Please provide the Nominee's address to send him/her a notification.

Nominee's Street Address​
Nominee's Address 2​
Nominee's City​​
Nominee's State​​
Nominee's Zip Code​
Nominee's email address​
Nominee's Phone​​
Nominee's Extension​

If the nominee is a student, please indicate the student's grade level.

Student grade level​

Please provide a description of the nominee's service which demonstrates their passion and commitment to go above and beyond their professional responsibilities to our students and/or to the broader special education community (e.g., staff members who volunteer their personal time in service of individuals with disabilities).

If possible, please attach 3 to 4 pictures of the nominee. Alternatively, pictures can be emailed to (please include "CAC Nominee pics" in the subject line and the nominee's name in the body of the email).

Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB
Max file size: 10 MB

As the individual making this nomination, please provide us with your information below

First name nominating person​
Last name of nominating person​​​
Stree address of nominating person​
Address 2 of nominating person​
City of nominating person​​
State of nominating person​​
Zip code of nominating person​​
Phone number of nominating person​​
Email of nominating person​