TCBSBM Outstanding Administrator Award Form

Personal Data:

Note: Application may be submitted by TCBSBM on behalf of educator they feel deserve special recognition for educational service.
Personal Information *

First Name Last Name
Position
Email *
example@example.com
School
Academic Levels
School Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
E-mail *

Educational Experience:

Please give details of all Schools/Colleges/Universities attended.

Secondary/Further/Higher Education

Name of Institutions

Dates Attendance

Degree / Diploma

Teaching, Counseling, Campus/District Leadership and Other Work Experience

Name of Institutions

Inclusive Dates

Title

Professional and Community Organization:

Educational Language Qualifications

Name / Organization

Office Position

Honors and Awards

Qualifications:

This section must be completed to learn what sets the nominee apart from other recipients
Performance over and above job description:
Performance of job duties in an exemplary and extraordinary manner to include such activities as curriculum development, tutoring without compensation, mentoring and other support activities.
Activities that benefit the community:
Evidence that the nominee participates in activities or organizations that benefit the community in such a way that it positively affects students. These activities could include volunteer work in public libraries, homeless shelters and community food banks as well as services such as reading for the blind and work with adult literary programs.
Activities that benefit students:
Relationship with staff students and the public that create a positive impact on the learning environment for the disadvantaged at-risk student, or minority student. This might involve counseling potential dropouts and gang members, sponsoring drug abuse program and providing services for handicapped and special learning needs students.
Activities exhibiting selfless conduct toward others:
Evidence that the nominee acts upon a genuine concerns for the welfare of others
Examples of innovation, creativity and leadership
Development of innovation and creative exercises, activities and projects in the classroom, campus or central office that promote student success.
Statement of professional philosophy
The philosophy that drives the nominee's attitude and actions.

Recommendation:

All applicants must provide a maximum of THREE letters of recommendations. Please list the names and email addresses of individuals who will provide letters of recommendation. They may send the letters to awards@tcbsbm.net.
Recommendation #1

First Name Last Name
Email #1
example@example.com
Recommendation #2

First Name Last Name
Email #2
example@example.com
Recommendation #3

First Name Last Name
Email #3
example@example.com
Declaration

I certify that, to the best of my belief, the information I have provided is complete and true.
Name of Nominee

First Name Last Name
Date

day month year
Signature

Clear

Nominators' Data

Please provide information regarding the TCBSBM member who nominated the nominee
Nominators' Name *

First Name Last Name
TCBSBM Nominator's Information

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country
Should be Empty:

Personal Data:

Educational Experience:

Professional and Community Organization:

Qualifications:

Recommendation:

Nominators' Data