RISE Nominee Submission Form

Recognizing Inspirational School Employees (RISE) Award

Nominee Submission Form

Background

The purpose of the Recognizing Inspirational School Employees (RISE) Award is to recognize and promote the commitment and excellence exhibited by full- or part-time classified school employees who provide exemplary service to students in pre-kindergarten through high school.¹

The U.S. Department of Education (Department) invites the governor of each state to nominate up to two classified school employees by November 1, 2022. The Secretary of Education will select a single classified school employee to receive the RISE Award for that school year in spring 2023. The Department will communicate the selectee’s story in order to inspire other innovative practices and excellence among classified school employees.

Governors shall consider nominations submitted by local educational agencies, school administrators, professional associations, labor organizations, educational service agencies, nonprofit entities, parents, and students, and any other groups they deem appropriate.

Contact Information

Governor’s Office Nominating Official:

Title (Mr./Ms./Mrs./ Dr.):       First Name:       Last Name:       Position:       Email:       Phone:      

How did this nominee come to your attention?      

Employee Nominated:

Title (Mr./Ms./Mrs./ Dr.):       First Name:       Last Name:       Position:       Email:       Phone:      

Entity that Employs Nominee:

Name:       Address:       City:       State:      Zip:      Twitter:       Facebook:      

Institution’s Top Official: Title (Mr./Ms./Mrs./ Dr.):       First Name:       Last Name:       Position (Principal/ Head of School):       Email:       Phone:      

(If Applicable)

School district or equivalent:

Superintendent: Title (Mr./Ms./Mrs./ Dr.):       First Name:       Last Name:       Email:      

Institutional Information

Employer type:

Multiple institutions

Early Learning

Elementary

Middle

High

Public

Charter

Magnet

Non-Public

Urban

Rural

Suburban

Demographics of school(s) where nominee serves:

Free and Reduced-Price Lunch Eligible:      

Student Population Ethnicity/ Race by Category:      

Limited English Proficient:      

Special Education:      

Total Enrolled:      

Documentation (Limit to 3 pages)

Describe how this nominee demonstrates excellence in (250 words maximum each section):

(A) Work performance      

(B) School and community involvement      

(C) Leadership and commitment      

(D) Local support (from co-workers, school administrators, community members, etc., who speak to the nominee’s exemplary work)      

(E) Enhancement of classified school employees' image in the community and schools      

(F) Any other areas the state deems exceptional and pertinent to the RISE Award      

Certifications

School and District Certifications

The signatures of the school principal and district superintendent (or equivalents) at which the nominee works on the next page certify that each of the statements below concerning the school’s compliance with the following requirements is true and correct to the best of their knowledge. In no case is a private school required to make any certification with regard to the public school district in which it is located.

1. The school has some configuration that includes grades early learning to 12.

2. Neither the nominated public school nor its public school district is refusing the U.S. Department of Education Office of Civil Rights (OCR) access to information necessary to investigate a civil rights complaint or to conduct a district wide compliance review.

3. OCR has not issued a violation letter of findings to the public school district concluding that the nominated public school or the public school district as a whole has violated one or more of the civil rights statutes. A violation letter of findings will not be considered outstanding if OCR has accepted a corrective action plan to remedy the violation.

4. The U.S. Department of Justice does not have a pending suit alleging that the public school or the public school district as a whole has violated one or more of the civil rights statutes or the Constitution’s equal protection clause.

5. There are no findings of violations of the Individuals with Disabilities Education Act in a U.S. Department of Education monitoring report that apply to the public school or public school district in question; or if there are such findings, the state or public school district has corrected, or agreed to correct, the findings.

I have reviewed the information in this application and certify that to the best of my knowledge all information is accurate.

Date:      

(Principal’s or Appropriate Supervisor’s Signature)

I have reviewed the information in this application and certify that to the best of my knowledge all information is accurate.

Date:      

(Superintendent or Appropriate Second Level Supervisor’s Signature)

Governor’s Office Signature

I have reviewed the information in this application and certify to the best of my knowledge that the school meets the provisions above.

Date:     

(Nominating Authority’s Signature)

Submission Instructions

Submit this completed form to [email protected] by November 1, 2022.

Public Burden Statement

According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless such collection displays a valid OMB control number. The valid OMB control number for this information collection is 1860-0510 and the expiration date is XX/XX/XXXX. Public reporting burden for this collection of information is estimated to average 30 hours per response, including time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. The obligation to respond to this collection is required to obtain or retain benefit under P.L. 116-13, Recognizing Achievement in Classified School Employees Act. Send comments regarding the burden estimate or any other aspect of this collection of information, including suggestions for reducing this burden, to the U.S. Department of Education, 400 Maryland Ave., SW, Washington, DC 20202-8420 or email [email protected] and reference the OMB Control Number 1860-0510. Note: Please do not send nominations to this address.

1 A classified school employee is an employee of a state or any political subdivision of a state, or an employee of a nonprofit entity, who works in any grade from pre-kindergarten through high school in any of the following occupational specialties: paraprofessional, clerical and administrative services, transportation services, food and nutrition services, custodial and maintenance services, security services, health and student services, technical services, and skilled trades. The terms used have the meaning given the terms in section 8101 of the Elementary and Secondary Education Act of 1965 (20 U.S.C. 7801).