NOMINEE STATEMENT FORM

THE ACS DIVISION OF CHEMICAL EDUCATION
SOUTHEAST REGION AWARD FOR EXCELLENCE
IN HIGH SCHOOL TEACHING

DEADLINE: For Local Section nominations: To Be Determined by the Local Section
DEADLINE: For transmitting nominations to be considered for the regional award: June 1, 2008

Nominations for the Southeast Region Award for Excellence in High School Teaching is a two-step process. First nominations must made to each Local Section. Then the Local Section must transmit those nominations to the SERMACS Awards Committee. This form is one of a set of 3 forms provided by the Executive Committee of the Southeast Regional ACS meeting for transmitting nominations to the SERMACS Awards Committee. These forms may also be used by Local Section Awards Committees to gather data for Local Section High School Teacher Awards. Please notify Greg-Grant@utc.edu if there are problems using the forms.

The deadline for submitting the nomination for the Regional Award is June 1, 2008. The Local Section deadlines are determined by each Local section. However, if these forms are used to gather data for Local Section nominstions, then then the SERMACS HS Committee strongly recommends that this and other forms be sumitted no later than April 1, 2008. The responses submitted by that date will be forwarded the Local Section chair or his/her designate to select the nominee for the regional award.

Any individual, except a member of the awards selection committee or a current student, may nominate or support a nominee during any given award year.

The Regional Award (not the local section award) carries a $1000 honorarium and will be presented during the Southeastern Regional Meeting of the ACS, which will be held on November 12-15, 2008 in Nashville TN.

Supporting documents describing this award:

• Information and Guidelines
• Scoring Rubric

NOMINATOR INFORMATION

Who nominated you for this award?

Name:

City:

State: State Alabama Georgia Florida Kentucky Mississippi North Carolina Puerto Rico South Carolina Tennessee Virginia

NOMINEE INFORMATION

Local section of nominee: Local Section Alabama Auburn Central Carolina Carolina-Piedmont Chattanooga Coastal Georgia East Tennessee Eastern North Carolina Florida Georgia Hampton Roads Jacksonville Lexington Louisville Kentucky Lake Memphis Middle Georgia Mississippi Mobile Nashville North Alabama North Carolina Northeast Tennessee Northwest Georgia Ole Miss Orlando Pensacola Puerto Rico Savanah River South Carolina South Florida Southwest Geogria Tampa Bay Virgina Virgina Blue Ridge Western Carolinas Wilson Dam UNKNOWN*

*Please ask the nominator for the local section name if it is not known not you.

Name:

Present Position (Exact Title):

School:

Address:

City:

State: State Alabama Georgia Florida Kentucky Mississippi North Carolina Puerto Rico South Carolina Tennessee Virginia Zip:

Telephone: (work)

Telephone: (home or cell)

Fax: (optional)

E-mail:

Website: (optional)

Give your current teaching assignment including course titles and grade levels. What is your involvement in extracurricular activities?

Provide a statement of not more than 500 words in which you present your teaching philosophy or otherwise describe your commitment to the profession.

Provide a curriculum vitae or resume that consists of you honors, professional activities, and additional evidence of service to the profession. this must be limited to activities with the past 5 years. If this statement has been created in a word processor document, please copy and past the text below.

RECOMMENDATION STATEMENTS

A copy of your statement submitted to this form will be forwarded to your references for their information. A completed nomination package requires references from:

• your nominator. Please notify him/her after you have submitted this form.
• your current principle or supervisor.
  
  Principle/supervisor e-mail:
  
  Telephone:
• additional optional letters of support from:
  
  Optional reference e-mail: (optional)
  
  Optional reference telephone: (optional)
• additional optional letters of support from:
  
  Optional reference e-mail: (optional)
  
  Optional reference telephone: (optional)

Please ask all of your references to use the following form.

http://www.ncsu.edu/chemistry/outreach/ACSserm/HSTeachersReference.html