Rhode Island Teacher of the Year Award
NOMINATION FORM
Part I
1. Nominee�s Name:_____________________________________________________
2. Home Address: _____________________________________________________
________________________________________________________
3. Telephone: Home: (_____)_______________ School: (_____)_______________
Fax: (_____)_______________ E-mail: _______________________
4. AAFCS Membership - Number: ________________ Length of time: _____________
5. Name of School: _________________________________________________________
6. School Address: _____________________________________________________
_____________________________________________________
_____________________________________________________
7. Phone: ________________ Fax: _______________ E-mail: ___________________
8. Position/Title (must be a permanent, full time family and consumer sciences teacher):
___________________________________________________________________
9. Grade(s) Taught: _________________________
10. Title of Nominee�s Program:_____________________________________________
_____________________________________________
11. Program Focus Area (check only one):
__________ Career Awareness / Job Training
__________ Consumer Education / Family Finance
__________ Creative Dimensions / Alternative Program Designs
__________ Family Life / Personal and Social Development
__________ Nutrition Education / Diet and Health
12. Identify colleges/universities you have attended; List most recent first.
Degree Major Institution Date received
_____________________________________________________________________________________
_____________________________________________________________________________________
_____________________________________________________________________________________
______________________________________________________________________________________
13. Professional experience. List most recent first.
Position Employer Dates Function/Responsibilities
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
___________________________________________________________________________________
14. Professional/Honorary Activities and Affiliations:
Years of Positions Held Organization Membership Honors Received Date(s)
_____________________________________________________________________________________
_____________________________________________________________________________________
______________________________________________________________________________________
14. Was this program created by the nominee? Yes: _______ No: ________
15. How long has this program been implemented by the nominee?