Milken Talent Pool Recommendation Form
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1. Talent Pool Recommendation Form
TALENT POOL RECOMMENDATION FORM
DEPARTMENT OF PUBLIC INSTRUCTION
STANDARDS AND ACHIEVEMENT
We invite you to recommend distinguished classroom teachers and/or principals who have demonstrated all of the following:
• Exceptional educational talent as evidenced by effective instructional practices and student learning results in the classroom and school;
• Exemplary educational accomplishments beyond the classroom that provide models of excellence for the profession;
• Individuals whose contributions to education are largely unheralded yet worthy of the spotlight;
• Early- to mid-career educators who offer strong long-range potential for professional and policy leadership; and
• Engaging and inspiring presence that motivates and impacts students, colleagues, and the community.
Please complete a separate form for each individual including a one-page letter explaining how this person meets the criteria outlined in this letter. Please include a resume for each recommendation.
Incomplete forms will be eliminated from this process.
THIS IS A CONFIDENTIAL PROCESS
INDIVIDUALS SHOULD NOT BE AWARE OF THIS RECOMMENDATION.
Name of Recommended Educator:
1
. Educator
Educator
First Name
Last Name
2
. Title
Title
Classroom Teacher
Principal
Other (please specify)
3
. Grades
Grades
For teachers, grade(s) currently teaching:
4
. Subjects
Subjects
Reading/English/Language Arts
Social Studies
Foreign Language (Please specifiy):
Science
Fine Arts
Mathematics
Other (please specify)
5
. Grade Levels
Grade Levels
For principals, grade levels in building:
Total Years in Education: If a Principal, number of years as an administrator:
6
. Years
Years
7
. Will the person be at the same school site next year?
Will the person be at the same school site next year?
yes
no
School District/Address:
8
. Information
Information
School District
School Name
School Street Address
City
State
ZipCode
School Phone (Ext.)
School Fax
Educator's Supervisor Name
Title
Supervisor's Phone (Ext.)
Supervisor's Fax
Supervisor's Email
RATE educator from 1-10 (10 being highest) on the following four criteria and provide a paragraph to explain your rating. Be detailed and thorough, with examples whenever possible.
9
. Exceptional educational talent as evidenced by effective instructional practices and student learning results in the classroom and school.
Exceptional educational talent as evidenced by effective instructional practices and student learning results in the classroom and school.
10
. RATE
1
2
3
4
5
6
7
8
9
10
A
*
RATE A 1
A 2
A 3
A 4
A 5
A 6
A 7
A 8
A 9
A 10
11
. Exemplary educational accomplishments beyond the classroom that provide models of excellence for the profession. Include committees, mentoring, awards, publications, presentations.
Exemplary educational accomplishments beyond the classroom that provide models of excellence for the profession. Include committees, mentoring, awards, publications, presentations.
12
. RATE
1
2
3
4
5
6
7
8
9
10
B
*
RATE B 1
B 2
B 3
B 4
B 5
B 6
B 7
B 8
B 9
B 10
13
. Strong long-range potential for professional and policy leadership, i.e., predict the educator's potential to remain in education for at least 20-25 more years and demonstrate leadership in the profession.
Strong long-range potential for professional and policy leadership, i.e., predict the educator's potential to remain in education for at least 20-25 more years and demonstrate leadership in the profession.
14
. RATE
1
2
3
4
5
6
7
8
9
10
C
*
RATE C 1
C 2
C 3
C 4
C 5
C 6
C 7
C 8
C 9
C 10
15
. Engaging and inspiring presence that motivates and impacts students, colleagues and the community. Do students perform at higher levels due to the educator, pursue certain careers, credit their success to the educator, etc.?
Engaging and inspiring presence that motivates and impacts students, colleagues and the community. Do students perform at higher levels due to the educator, pursue certain careers, credit their success to the educator, etc.?
16
. RATE
1
2
3
4
5
6
7
8
9
10
D
*
RATE D 1
D 2
D 3
D 4
D 5
D 6
D 7
D 8
D 9
D 10
17
. Cite evidence of student achievement gains as a result of the educator's practices:
Cite evidence of student achievement gains as a result of the educator's practices:
18
. Cite awards the educator has received:
Cite awards the educator has received:
19
. Other comments:
Other comments:
20
. Education
Education
School Attended
Degrees
Graduation-Year
School Attended
Degrees
Graduation-Year
School Attended
Degrees
Graduation-Year
Please list the names and phone numbers of three references other than you for the educator. We will call and interview them. They should know the educator currently and very well.
21
. Reference-1
Reference-1
Name
Title
Phone (W)
Phone (H)
Email
22
. Reference-2
Reference-2
Name
Title
Phone (W)
Phone (H)
Email
23
. Reference-3
Reference-3
Name
Title
Phone (W)
Phone (H)
Email
24
. Your Name
Your Name
Name
Title
Phone (W)
Phone (H)
Email
Return completed letter(s) and resume(s) by mail to:
ND Department of Public Instruction
Talent Pool Program Administrator
600 E Boulevard Ave., Dept. 201
Bismarck, ND 58505-0440
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