VTASCD Promising Educator Award Nomination Form

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Please review the form below in its entirety and have all the information required on hand before filling it out.

All input fields must be filled in except those noted as optional

NOMINATOR'S INFORMATION
First Name:
Last Name:
VTASCD Member:	Yes No
Position:
Work Address:
Country:
Work Phone:
Home Phone:
Fax Number (Optional):
E-mail Address:
NOMINEE'S INFORMATION
First Name:
Last Name:
Position:
Country:
Work Phone:
Home Phone:
Fax Number (Optional):
E-mail Address:
Number of Years in Education:

DESCRIPTION OF NOMINEE'S ACHIEVEMENTS

What has this nominee accomplished in teaching and learning that motivates you to nominate him or her for the VTASCD Promising Educator Award? In the boxes below, cite specific evidence of the nominee's impact on educating the whole child, leadership, students, and contributions to the profession. In each of the four sections, there is a link to the criteria to help inform your response. The VTASCD Selection Committee will use these criteria to guide its initial candidate rating.

Educating the whole child ( description ) (300 Words Maximum)

Leadership ( description ) (300 Words Maximum)

Impact upon students ( description ) (300 Words Maximum)

Contribution to the profession ( description ) (300 Words Maximum)

ADDITIONAL NOMINEE INFORMATION

Provide the nominee's education degree information.

List the nominee's work experience over the last 10 years, beginning with his or her most recent experience first.

List awards and honors the nominee has received.

List any other accomplishments the nominee has achieved within the last three years. Include published work, conference presentations, professional offices held, volunteer community services, etc.

REFERENCES

Select two individuals who are familiar with the nominee's achievement.

Name:
Position:
Work Phone:
E-mail Address:

Name:
Position:
Work Phone:
E-mail Address:

I certify that all the statements made here are true, complete, and accurate to the best of my knowledge.

Signature: (By checking this box you are signing this nomination.)