Applications due: April 9, 2018 2018 Claire Friedlander Upstander Award Application Applicant Information Name Home Address City ST ZIP Code Phone number(s) School & grade E-Mail Address How did you hear about the Friedlander Award? Advertisement Twitter HMTC email/newsletter Family or friend Facebook Other (please specify): Nominator information Name Street Address City ST ZIP Code Home Phone Work Phone E-Mail Address Relationship to nominee Signature Release Form and Signature I hereby transfer all copyrights in the Application to the Holocaust Memorial and Tolerance Center of Nassau County, Inc. It is my understanding that the Center may publish and/or exhibit the Application and include the Application in brochures and other media. I understand that winners will be expected to participate in publicity related to the HMTC and the Friedlander Upstander Award, including but not limited to: photographs, films, and interviews which may appear on websites, social media, and in print media. Winners may also be asked to participate in our Annual Middle School Upstander Conference in the fall semester. Name (printed) Student signature Parent/guardian signature Date of application Please Attach Nominator Letter and Student Essay (maximum 1 page each) Holocaust Memorial and Tolerance Center of Nassau County, Welwyn Preserve 100 Crescent Beach Road, Glen Cove, NY 11542 – 516-571-8040 www.hmtcli.org –
Applications due: April 9, 2018 2018 Claire Friedlander Upstander Award Application Applicant Information Name Home Address City ST ZIP Code Phone number(s) School & grade E-Mail Address How did you hear about the Friedlander Award? Advertisement Twitter HMTC email/newsletter Family or friend Facebook Other (please specify): Nominator information Name Street Address City ST ZIP Code Home Phone Work Phone E-Mail Address Relationship to nominee Signature Release Form and Signature I hereby transfer all copyrights in the Application to the Holocaust Memorial and Tolerance Center of Nassau County, Inc. It is my understanding that the Center may publish and/or exhibit the Application and include the Application in brochures and other media. I understand that winners will be expected to participate in publicity related to the HMTC and the Friedlander Upstander Award, including but not limited to: photographs, films, and interviews which may appear on websites, social media, and in print media. Winners may also be asked to participate in our Annual Middle School Upstander Conference in the fall semester. Name (printed) Student signature Parent/guardian signature Date of application Please Attach Nominator Letter and Student Essay (maximum 1 page each) Holocaust Memorial and Tolerance Center of Nassau County, Welwyn Preserve – 100 Crescent Beach Road, Glen Cove, NY 11542 516-571-8040 – www.hmtcli.org
CF-Award-APPLICATION-2018-3.docx