2024 Nomination Deadline:
Forms due to the TASA office no later than Friday, November 17, 2023.

If you have questions about the program or need assistance, please contact
Debbie O'Donnell, Coordinator, Membership and Registration Services, 512.852.2108.

Nominee: *

Date of Retirement: * +

District / Organization Retired From *

Position Retired From: *

Years of Service in Texas: *

Years of Service in Other States:

Address: (if known, provide mailing address after retirement)

City:

State:

Zip Code:

Current E-mail:

E-mail After Retirement (if different):

Phone:

Nominator's Information

Nominated By: *

Nominator's Email *

Nominator's Address:

City:

State:

Zip Code:

Nominator's Phone:

Help us correctly pronounce your name and district. Please share with us any tips on how to pronounce your name and district. For example: Jill Siler, Gunter ISD - Jill (rhymes with hill); Siler (sigh-ler); Gunter (gun-(t)-er - the "t" is silent). *

OPTIONAL: To help assist with the correct pronunciation of your name and district, you can use your camera video or voice memo app and upload a file. Please include your name and district.