Award Nomination Form

WITEA Awards
WITEA Teacher of the Year Ken Pattie Award
(25 years of teaching technology)
Technology Program of the Year Outstanding Vendor Award
WITEA Tom Staly Service & Leadership Award
ITEA Awards
ITEA Teacher of the Year Distinguished Technology Educator
ITEA Program of the Year Special Recognition Award
Nominee Information
Name of Nominee Nominated for: (award)
Nominee's Current Title / School / District

Subjects Taught and/or Duties
WITEA Member? __ yes (required) for ______ years starting in _______ ITEA Member? __ yes (required) for ______ years starting in _______
Describe the outstanding features of the program (Program of the year nomination) or
Describe the outstanding qualities of the nominee's teaching (Teacher of the year)
Nominee's professional activities and contributions; school and community involvement:
Work Address City State Zip
Work Phone Home Phone

Name and position of individual making nomination:

 

Signature of individual making nomination:

 

Work Address City State Zip
Home Address City State Zip
Work Phone Home Phone


Mail completed form to:


Criner, Mike
Concrete School District
P.O. Box 402
Concrete, WA 98237
Ph. 360-853-8143 ext. 204      Fax 360-853-8110      criner9604@msn.com