WASTS Award Nomination Form

1. Default Section

Nomination Instructions:
Before you begin, please review the guidelines for your specific award for help in filling out this application. If you have any further questions, please contact WASTS at april.stonebreaker@wasts.us Please complete this form and submit with your support materials. All sections must be completed in order for this application to be considered. The photo will be used for publications. All materials must be submitted by September 30, 2010. If possible, please email a digital photo to: april.stonebreaker@wasts.us . Digital photographs should be at least 300 dpi and in a .jpg format.

1. Type of Award:

Type of Award: WASTS Outstanding CTE Teacher of the Year

WASTS Outstanding New CTE Teacher of the Year

WASTS Outstanding Teacher in Community Service

WASTS Lifetime Achievement Award

WASTS Outstanding Service Award

WASTS Support Staff Award

WASTS Outstanding CTE Program Award

WASTS CTE Administrator of the Year

2. Biographical Information of Nominee:

Biographical Information of Nominee: Name:
Employer:
Title:
Business Address:
City:
State:
Zip:
Business Telephone:
Fax:
Preferred E-mail:
Home Address:
City:
State:
Zip:
Home Telephone:
Mobile:
Subject Currently Teaching and/or Duties:

3. Membership Information

Membership Information WASTS Member for how many years?
Membership started what year?

4. Cluster Affiliation:

Cluster Affiliation: How many years?
Beginning in what year?

5. Nominator Information (Nominators Must Be WASTS Members)

Nominator Information (Nominators Must Be WASTS Members) Name of Nominator:
Title:
Business Address:
City:
State:
Zip:
Telephone:
Fax:
Preferred E-mail:

6. Reason for Nomination:

Reason for Nomination: