Eliza Pickrell Routt Award Application

Eliza Pickrell Routt Award Application

for outstanding voter registration efforts in registering 85% or more eligible high school seniors to vote.
School Name
Please enter the school name how you would like it to appear on the award.
School Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
What county is the school in?
If the school is in more than one county, please list them here
What school district is the school in?
Teacher or Administrator

First NameLast Name
Teacher or Administrator Title
Teacher or Administrator Email
example@example.com
Teacher or Administrator Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Leader(s)
Please enter names of all students who worked towards the voter registration goal.
Number of eligible seniors
Percentage of seniors registered
How would you like the award presented?
Please select a date & time for a presentation. We will confirm via email. If necessary, we will reschedule via email.

MonthDayYear
Hour MinutesAM/PM Option
If the above listed Teacher or Administrator is not the best contact to coordinate award delivery, please list the best contact and their email and/or phone number

Best Contact First NameBest Contact Last Name
Best Contact Email
example@example.com
Best Contact Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
The school listed above has registered at least 85% of its eligible seniors as Colorado Voters. They have met the criteria for the Colorado Secretary of State's Eliza Pickrell Routt Award.
Should be Empty: