Student of the Month Nomination



Open to grades K-12, KCRG-TV9's Student of the Month program features three outstanding students who will be recognized for their positive student citizenship, academic success, volunteer achievements, or outstanding teamwork. Nominate a student whom you feel showcases exceptional work inside or outside the classroom for their chance to be KCRG-TV9's Student of the Month.

Our judges select the top 3 nominees based SOLELY on the information from this form. Please include as much information and detail on the student as possible.


PLEASE INCLUDE A PHOTO OF THE STUDENT YOU ARE NOMINATING. (You will be prompted on the next page. Photo must accompany the nomination.)
1.Student's Information
First Name*
Last Name*
Student's Age*
Student's School*
Student's Current Grade*
Student's Guardian*
Guardian's Phone Number
Contact Information for Guardian / Best Time to Contact*
2.What specific character traits does the student possess that makes them stand out?*
3.How would you characterize the student’s academic achievements?*
4.What is the student involved with outside of the classroom?*
5.Describe challenges or circumstances that this student has overcome to be successful.*
6.Is there anything else that you would like us to know about what makes this student special? The more information you can provide, the better.*
7.How do you know the student you are nominating?*
8.Nominator's Information (Additional nominators are encouraged to submit additional nominations for a student.)
Your First Name*
Your Last Name*
Your Email Address*
Additional Reference's Name
Additional Reference's Email Address
9.Please enter your date of birth.
Month* Day* Year*

10.Terms and Conditions
I have read, understand, and agree to the Website usage agreement and privacy policy.
* represents required fields

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