Township of North Brunswick
Scholar / Athlete Nomination Form
Department of Parks and Recreation
710 Hermann Road
North Brunswick , NJ 08902
Attention: Lou Ann Benson
(732) 247 - 0922 ext 478

The Department of Parks, Recreation & Community Services
recognizes a Scholar / Athlete each month. DPRCS encourages nominations in the form of a one-page letter explaining your suggested nomination. A copy of the student's report card should be attached. The Scholar / Athlete / Artist selected will be invited to a Council Meeting to receive a proclamation from the Mayor and Council and receive an achievement certificate from the Department. Light refreshments are served, at the proclamation ceremony and family and friends are encouraged to join in the celebration!

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Name/ School / Grade of student nominated_______________________________

Home phone number of student___________________________

Name and phone number of Nominator________________________