GEORGIA SCHOOL BOARDS ASSOCIATION
BOARD SERVICE RECOGNITION
2016 Notification Form
This program recognizes local public school board members who have served 15 (15 to 24), 25 (25-29), or 30+
years of consecutive or non-consecutive years on their local board or another public school board of education.
This recognition can also be provided posthumously to honor deceased school board members.
Please submit the name(s) and documented service of school board members who are eligible. Honorees will
receive a special pin and their names will be listed in the 2016 GSBA/GSSA Annual Conference program. The
names must be submitted by October 1, 2016, in order to be listed in the program. Please note that this is a
milestone award. Pins are given only once at each plateau. If one or more of your board members
received a pin in previous years, please do not submit their name again unless they have reached a new
plateau.
School System:
Name of Nominee:
Dates of Services:
Address/Phone Nos./Email Address of Nominee:
Years of Service:
Name of Nominee:
Dates of Services:
Address/Phone Nos./Email Address of Nominee:
Years of Service:
Name of Nominee:
Dates of Services:
Address/Phone Nos./Email Address of Nominee:
Years of Service:
Which of the above board members are attending the GSBA/GSSA Conference on Saturday,
December 3, 2016 to receive their award?
Form Completed by:
Phone No.:
Title:
Email Address
Form must be submitted to the following address by October 1, 2016
Nancy McLellan, GSBA Administrative Assistant
5120 Sugarloaf Parkway
Lawrenceville, GA 30043
(770) 962-1546 (fax)
Email: [email protected]
Phone: 1-800-226-1856, ext. 3634, or 770-822-3634
This form may be duplicated.