NOMINATION FORM FOR
LONG ISLAND HIGH SCHOOL STUDENT RECOGNITION AWARD

(ONLY FOR HIGH SCHOOLS IN QUEENS, NASSAU AND SUFFOLK COUNTIES)
(Please Consult With Colleagues Before Submitting This Form)
Deadline: 2 Weeks Before Award Is Needed or May 16, 2008
Please Give Each Student and School Name As They Should Appear on The Award
High School Name
Principal Name
Guidance Councilor Name
High School Street Address
High School Street Address2
City, State  Zip ,
Phone (XXX-XX-XXXX)
Fax (XXX-XX-XXXX)
Nominator Name
Nominator E-mail address (required)
Re-type Nominator E-mail address (required)
Other chemistry teachers consulted in decision (Name, Email)
Student Name
Student Street Address
City, State  Zip ,
Will the student attend dinner at OSI Pharamceuticals on June 2, 2008?  
Date of Your High School Awards Ceremony (optional)

PLEASE... Review the above data for accuracy before submitting.