10/14/2013 (School Name Application-CGR) Page 1
Clark County School District
School Name Committee
Facility Name Application
Naming Existing Portions of School or Nonschool Facilities
Periodically, names are submitted to the School Name Committee to dedicate a portion of a school or non
school facility to honor distinguished citizens and educators.
Prior to a nomination and application being presented to the School Name Committee for
consideration, the administrator of the intended facility must be informed of your request.
All nominations are made available to the public for review and are posted on the Clark County School
District’s website at ccsd.net.
NEW FACILITY OR EXISTING PORTION OF FACILITY TO BE NAMED:
LOCATION:
PROPOSED NAME:
ADMINISTRATOR OF FACILITY: PHONE NUMBER:
ADMINISTRATOR APPROVAL OBTAINED? O YES O NO
NOMINEES OCCUPATION:
IS THE NOMINEE A FORMER CCSD EMPLOYEE? O YES O NO IF SO, HOW MANY YEARS RETIRED?
DATE OF BIRTH:
CITY:
STATE:
YEARS IN CLARK COUNTY:
COUNTRY OF CITIZENSHIP:
PERSON SUBMITTING THE NOMINATION:
ADDRESS:
CITY:
STATE:
ZIP CODE:
HOME PHONE:
OFFICE PHONE:
EMPLOYMENT IN THE CLARK COUNTY SCHOOL DISTRICT (list positions held and length of time in each, attach an
additional sheet if needed)
EDUCATION-RELATED POSITIONS HELD OUTSIDE THE CLARK COUNTY SCHOOL DISTRICT (list positions held, length of time in
each position, and impact on K-12 education in Clark County. Attach an additional sheet if needed)
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INVOLVEMENT IN ORGANIZATIONS OR ACTIVITIES BENEFITTING CHILDREN (attach an additional sheet if needed)
GOVERNMENT SERVICE (please explain how the nominee’s activities have contributed to children or education or
to the betterment of Clark County, attach an additional sheet if needed)
ASSOCIATION WITH THIS NOMINEE AND THE EXISTING FACILITY (attach an additional sheet if needed)
FOR AN EXISTING FACILITY, WHAT CONTACT HAS BEEN MADE WITH THE SPECIFIED FACILITY/SCHOOL/ADMINISTRATIVE
OFFICE/PARENT GROUP? DO THEY SUPPORT THIS NAMING? (attach an additional sheet if needed)
SPECIAL ATTRIBUTES, TALENTS, ACCOMPLISHMENTS, OR CONTRIBUTIONS NOT LISTED ELSEWHERE (please explain their impact
on children and education in Clark County, attach an additional sheet if needed)
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On a separate sheet of paper, please provide five (5) names of references, including addresses and
phone numbers. References may not be related to the nominee. In addition, the committee will
consider no more than three (3) letters of recommendation for each individual or joint nominee(s).
Please provide documentation of school/parent support of requested change.
Clark County School District Policy 7223, which governs the naming of District facilities and portions of
facilities states:
Portions of school or nonschool facilities, (including libraries, athletic fields, multi-purpose rooms,
theaters, etc.), may be named for former district employees or citizens who have made specific
contributions to education in Clark County.
Names of district personnel will not be considered while actively employed by the Clark County
School District
Names of Board members may not be considered while actively serving on the Board of Trustees, in
accordance with NRS 338.200.
Names of elected officials will not be considered while they are actively serving in public office.
Please submit application and supporting documentation to Clark County School District,
Community and Government Relations, 5100 West Sahara Avenue, Las Vegas, NV 89146.
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