Innovative Educator Nomination Form

At the April 14, 2015 Advisory Council Meeting, three educators, selected by the WVIZ/PBS Advisory Council Steering Committee, will be provided with the opportunity to present their outstanding examples of how they are transforming instruction while integrating instructional technology.

Selected educators will be provided 20 minutes to share: a demonstration, an overview of exemplary methodologies, an innovative integration of technology into teaching, or technology used to create student products.

Please nominate an educator that you feel demonstrates the above in an exemplary way.

Nominations are due by January 30, 2015.

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* 1. Name of Nominee
Please enter both First & Last names.

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* 2. School District

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* 3. School Building

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* 4. Email Address

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* 5. Phone Number
Please use the following format: (xxx-xxx-xxxx)

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* 6. Grade / Subject Taught or Specialty

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* 7. Name of Nominator
Please enter both First & Last names.

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* 8. School District

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* 9. School Building

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* 10. Email Address

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* 11. Phone Number
Please use the following format: (xxx-xxx-xxxx)

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* 12. Does the nominee know that he/she is being nominated?

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* 13. Nomination Summary:
Please explain why you are nominating this teacher as an exemplary or innovative practitioner who has enhanced educational transformation through the integration of instructional technology.
Maximum: 250 Words

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