Oregon Educator Talent Pool Recommendation Form

Please complete this form and email it to Jenni Knaus at . If you have any questions about the recommendation process, feel free to contact Jenni by email or phone at (503)947-5860.

Your Information Nominee Information

This form may be shared with other organizations to recognize outstanding educators.

Form 581-1381-I (03/09)

Name:

Job Title:

Relationship to Nominee:

Work Phone:

Home Phone:

Email:

Best way to contact:

Name:

Subject/Grade/Position:

School:

Total Years in Education:

Ethnicity (needed for some awards):

Email:

Principal/Supervisor:

Principal/Supervisor home phone:

This form may be shared with other organizations to recognize outstanding educators.

Form 581-1381-I (03/09)

References – Please include the names and contact information for at least 3 others who would be good references for the nominee. These could be colleagues, community members, or supervisors etc who would be knowledgeable about his/her work.

This form may be shared with other organizations to recognize outstanding educators.

Form 581-1381-I (03/09)

Reference 1

Name:

Relationship to nominee:

Work Phone number:

Home Phone number:

Email:

Reference 2

Name:

Relationship to nominee:

Work Phone number:

Home Phone number:

Email:

Reference 3

Name:

Relationship to nominee:

Work Phone number:

Home Phone number:

Email:

Reference 4

Name:

Relationship to nominee:

Work Phone number:

Home Phone number:

Email:

This form may be shared with other organizations to recognize outstanding educators.

Form 581-1381-I (03/09)

Please rank this educator in comparison with others you have known.

Truly Exceptional – Top 1%

Outstanding – Top 5%

Excellent – Top 10%

Comment on ranking:

Date Submitted:

Questions About Nominee – Please answer as many questions as you feel relevant to your nominee and include examples.

  1. Tell us a story that captures the educator’s character and teaching style?
  1. What sets this educator apart? What is he/she doing that is innovative, creative, inspiring, or especially effective?
  1. Describe the educator’s outstanding instructional practices in the classroom, school, and/or profession?
  1. Describe this educator’s leadership at the school, district and/or state level?
  1. Please cite evidence of student achievement as a result of the educator’s practices?
  1. List any awards or recognitions this educator has received:
  1. How long has this educator been teaching or serving students?
  1. If you ranked this educator in the top 1% of all educators at the beginning of this form, please note whether you would like this nomination to also serve as a nomination for the Oregon Teacher of the Year award.

Yes No

This form may be shared with other organizations to recognize outstanding educators.

Form 581-1381-I (03/09)