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Solano County SELPA Community Advisory Committee 2020-2021 Annual Recognition Nomination Form

The Solano County Community Advisory Committee (CAC) is accepting nominations of students, community members, and district staff who have gone above and beyond in service of students with disabilities within the Solano County SELPA regional boundaries: Benicia, Dixon, Fairfield-Suisun, Travis, and Vacaville Unified School Districts, and the Solano County Office of Education, during the 2020-2021 school year.

Nominations are due no later than March 12, 2021. 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 email address​​

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).

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

First name nominating person​
Last name of nominating person​​​
Phone number of nominating person​​
Email of nominating person​​