Nomination for Outstanding Teacher Award

FORM VIII

(SHEET 1 OF 4)

NOMINATION FOR OUTSTANDING TEACHER AWARD

( ) LESS THAN 10 YRS. ( ) MORE THAN 10 YRS

INSTRUCTIONS: This form is to be used by the Regional Counselor and the local science clubs to nominate a sponsor or a science teacher from a school for one of the annual awards of Outstanding Science Teacher sponsored by the Alabama Academy of Science and the Alabama Junior Academy of Science. This form must be received by the AJAS State Counselor by the annual meeting date. If mailed, send to:

B. J. Bateman, Jr.

Department of Mathematics and Physics

AJAS State Counselor

Troy University

Troy, AL 36082

1. Nominated Teacher's Name: ______

2. Teacher's Position: ______

3. Home Address: ______

City______Zip Code______

Telephone Number______

4. School Name: ______

School Address: ______

City______Zip Code______Phone______Fax______

Principal's Name: ______

5. AJAS Region: ______

6. Nominated Teacher's Activities:

AJAS Club Sponsor: No______Yes______Number of Years______

Other Science-related activities: ______

______

______

Community Activities which contribute to school-community relations:

______

______

______

FORM IX (Sheet 2 of 4)

7. Teaching Experience: Total Years: ______

Previous Teaching Positions: ______

______

Membership in State and National Professional Organizations: ______

______

Activities with young people exclusive of school: ______

______

8. Evidence of superior interest, dedication and skill in teaching of science

______

______

______

______

9. Name and Address of AJAS Science Club Making This Nomination:

Club Name: ______

School Address: ______

10. Name and Address of Person Making Out This Form:

Name:______

Address: ______

Telephone Number:______

SUPPLEMENT TO FORM IX

(Sheet 3 of 4)

AJAS ACTIVITIES INFORMATION FORM

This form should be completed along with Form IX and returned according to the instructions given with Form IX. It is quite important that the information given here is included with Form IX since the judges will put considerable emphasis on the response to these questions.

1. How long has the nominee been a member of the Alabama Academy of Science? ______

2. How many meetings have you attended of the AJAS? ______

3. What offices have you held in (a) Alabama Academy of Science______

______

(b) Alabama Junior Academy of Science ______

______

4. How long have you been the teacher/sponsor of the AJAS club at:

(a) Your present school ______(b) Other school______

5. How many AJAS offices have you had among your students, both on a regional and state level? ______What offices and what years? ______

______

6. How many AJAS paper readers have you had? ______List the years and number of winners. ______

How many of these were winners at State Competition?______

7. How many individual project winners at the state AJAS meeting have you had among your students? ______

8. Additional AAS and AJAS activities:

______

______

______

(sheet 4 of 4)

SUPPLEMENT TO FORM IX (To be done by teacher if award is received)

BIOGRAPHICAL INFORMATION

This information will be used only for publicity and will not be considered in the selection of the award recipient.

1. Teacher's Name: ______

2. Place of Birth: ______

3. Date of Birth: ______(Optional)

4. Elementary School(s) attended______

5. Secondary School(s) attended ______

6. Year of graduation and high school______

7. College education:

Colleges attended: ______

Degrees awarded: ______

Date awarded: ______

8. Graduate School education:

University attended: ______

Degrees awarded: ______

9. Teaching Experience:

Total Years Teaching: ______

Previous Teaching Positions: ______

______

10. Parent's Name: ______

11. Brothers and Sisters: No. of Brothers______No. of Sisters______

Additional general information:

______

______