Internal/Conf Generic Template

U.S. Academy Recognition Awards:
Nomination Form for Relationships

Instructions

· Complete a separate form for each nominee and category. Nominees can be entered in multiple categories. You can also nominate yourself.

· Attach your completed nomination to an e-mail and send it to .

· Submit all nominations by 5 p.m. Eastern Time on Friday, March 30, 2007. Nominations received after the deadline will not be considered.

Nominator Information

Your name: E-mail address:

Academy: Location (city and state):

Nominee Information

Name: E-mail address:

Academy: Location (city and state):

This nominee is an: q Instructor q Academy

Which population is the instructor or Academy serving as it relates to this nomination?

q Grades 6-8 q Grades 9-12 q Community college

q 4-year college or university q Postgraduate q Nontraditional

Category: Relationships

There are two dimensions of relationships: one is creating classroom relationships with students to ensure optimal learning and the other is establishing strategic relationships to create more opportunities for students. Nominees can demonstrate one or both of these dimensions.

Category / Criteria
Instructor / Describe how the instructor personalizes the classroom environment and instruction to support student progress, or describe any relationships the instructor has formed with organizations, schools, businesses, or community members to extend the reach of the Academy program
How does the instructor connect with students as a group and individually?
What resources are available to assist students who are struggling?
What partnerships been established outside of the school to help students with career development?
Category / Criteria
Academy / Describe administrative support and policies in place to personalize instruction for students, or describe how the Academy builds and maintains relationships with businesses, community organizations, educational institutions, and others to extend the reach of the Academy program and encourage student success
How does the Academy encourage personalized instruction for student success?
Has the Academy built relationships that support the educational and career goals of students?

Nominee Description

Describe how the nominee has fulfilled the criteria for relationships. Identify one or both dimensions of relationship building as demonstrated by the nominee: creating classroom relationships with students or establishing strategic relationships to create more opportunities for students. Include specific details about the factors and outcomes that set this nominee apart. Use the questions provided to help formulate your narrative. (Limit description to 500 words.)