NuLine Foundation | EmBraces Program

Teacher Nomination Form

Thank you for taking the time to nominate a student for the EmBraces program.

Nominate a Student

Please complete the form below to nominate a student who has been affected by bullying for a chance to receive FREE orthodontic treatment through the EmBraces program. All information will be kept confidential.

Teacher Information

Teacher's Full Name

Teacher's Email

Teacher's Phone

School Name

Student Information

Student's Full Name

Nearest NuLine Office

Student's Current Grade

Student's Date of Birth

Tell Us About This Student

Tell us about the child and their experience with bullying

Please describe the student's situation, any incidents of bullying they have experienced, and how it has affected them.

Why do you think we should choose this student?

Tell us why this student deserves to be selected for the EmBraces program.

Student's Interests (optional)

What does this student enjoy? (sports, music, art, hobbies, etc.)

By submitting this form, you confirm that you have permission to share this student's information for the purposes of the EmBraces program. Nominations are kept confidential.