12/18/2015
Champions for Excellence in Teaching and Learning Award
Champions for Excellence in Teaching and
Learning Award
* Required
Nominate a Champion for the Excellence in Teaching and
Learning Award
Do you know a champion for excellence in teaching and learning? The Department of Public Instruction wishes to recognize champion educators and education advocates during the 2016 Collaborative Conference for Student Achievement. The purpose of the Champion Award is to share our collective belief in the power of public education and to celebrate everything that is right about our local schools and the people who make it so.
Please take a moment to nominate that deserving teacher, administrator, classified staff or volunteer who is a champion for excellence in teaching and learning.
Individuals supporting excellence in teaching and learning are eligible for this award. The conference will be held March 21­23 at the Sheraton Greensboro Four Seasons Sheraton Greensboro Four Seasons/Koury Convention Center, March 21 – March 23, 2016. (Visit http://www.ncpublicschools.org/academicservices/conference/ for more information about the conference.)
Submitting a Nomination
Nominations will be accepted January 1 – 31, 2016. To ensure you submit a complete nomination, complete the following steps:
https://docs.google.com/forms/d/1ORYwUiPWRXDm_1g7u6VC9zBMuZfCxtvSLw­LN9HVtfk/edit?usp=drive_web
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Champions for Excellence in Teaching and Learning Award
• Identify the appropriate nomination category for your nominee.
• Review the criteria for nominee’s category. Your nomination should include examples about how the nominee meets each of the specified criteria.
• Complete the nomination form.
• You will receive an email confirmation that your nomination has been received and is complete. If you do not receive an email confirmation, contact the CCSA Hotline at (919) 807­
3630 or ccsa@dpi.nc.gov.
Tips for Submitting a Nomination
Be specific in describing the contributions of the individual you are nominating. Point to real improvements and tangible impact, using multiple examples if you like.
Make sure you are responding to the indicators posed on the form, not just providing a general description of work done by your candidate. Nominations do not have to be long to be effective, but please provide enough background so that the impact of your nominee's contributions to excellence in teaching and learning is clear. It is important to explain in detail any initiatives or projects mentioned so that the selection committee understands the nominee's accomplishments fully.
Take care to explain any technical terms and "insider jargon" in everyday language, and please don't worry too much about your writing. In this case, it's more about what you say and less about how you say it. But do remember to be specific!
We suggest creating your text in a Word document, then cut and paste your information into the nomination form.
Start this form over.
Nomination Categories and Criteria
Nominees for the Champions for Excellence in Teaching and Learning must:
Following are nomination criteria for CCSA Champions for Excellence in Teaching and Learning Awards. The criteria for each award are centered on the four basic qualities of potential, team, community and communication. Although the underlying qualities are the same, the details of those qualities differ in each category, please read carefully the specifics of your nominee’s category. Your nomination should include detailed examples about how the nominee meets the specified criteria.
1. Select your category *
Mark only one oval.
Educators Administrators After the last question in this section, skip to question 12.
After the last question in this section, skip to question 16.
Classified/Support Staff After the last question in this section, skip to question
20.
Volunteers (Parent, Business, Non­profit Organization, Local Education Board
Member) After the last question in this section, skip to question 24.
2. First Name *
https://docs.google.com/forms/d/1ORYwUiPWRXDm_1g7u6VC9zBMuZfCxtvSLw­LN9HVtfk/edit?usp=drive_web
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Champions for Excellence in Teaching and Learning Award
3. Last Name *
4. Job Title: *
5. Email Address: *
6. Home Address:
7. City, State, Zip
8. Phone Number: *
9. Alternate Phone Number:
10. School Name: *
11. School Department
Educators
Complete a narrative for each criteria.
12. Guides Students to Reach Their Full Potential
Describe how your nominee DEMONSTRATES support for education excellence at a K­12
public school, ENCOURAGES students to learn and enjoy their learning and ENGAGES
student interests.
https://docs.google.com/forms/d/1ORYwUiPWRXDm_1g7u6VC9zBMuZfCxtvSLw­LN9HVtfk/edit?usp=drive_web
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Champions for Excellence in Teaching and Learning Award
13. Instructional Leader and Team Player
Describe how your nominee PROVIDES inspiration and support, MENTORS students and
staff, and PLACES student needs first.
14. Positive Member of the Community
Describe how your nominee POSITIVELY influences school community, PARTICIPATES in
various aspects of the school and ACTIVELY contributes to the community.
15. Excellent Communicator
Describe how your nominee ARTICULATES ideas for students, COMMUNICATES often and
effectively with parents and staff, and ADVOCATES for the school and district.
Skip to question 28.
Administrators
Complete a narrative for each criteria.
16. Develops Potential in Students and Staff
Describe how your nominee BUILDS capacity of staff in order to facilitate student learning,
ENCOURAGES students to learn and enjoy their learning, and INITIATES student
achievement programs.
https://docs.google.com/forms/d/1ORYwUiPWRXDm_1g7u6VC9zBMuZfCxtvSLw­LN9HVtfk/edit?usp=drive_web
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Champions for Excellence in Teaching and Learning Award
17. Organizational Leader and Team Player
Describe how your nominee PROVIDES inspiration and support, ACTS as a role model for
all students and staff, and PLACES students’ needs first.
18. Leader in the Community
Describe how your nominee POSITIVELY influences school and community,
PARTICIPATES in various aspects of the school, and ACTIVELY contributes to the service
of the community.
19. Excellent Communicator
Describe how your nominee SHARES educational vision of the school and district,
COMMUNICATES often and effectively with students, staff, parents and community, and
ADVOCATES for the school, district and education.
Skip to question 28.
Classified/Support Staff
Complete a narrative for each criteria.
20. Encourages Students to Reach Their Full Potential
Describe how your nominee SUPPORTS educational mission, ENCOURAGES students to
learn and enjoy their learning, and ENHANCES quality of student experience.
https://docs.google.com/forms/d/1ORYwUiPWRXDm_1g7u6VC9zBMuZfCxtvSLw­LN9HVtfk/edit?usp=drive_web
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Champions for Excellence in Teaching and Learning Award
21. Team Player
Describe how your nominee PROVIDES inspiration and support, MENTORS students, staff
and peers, and PLACES student needs first.
22. Supports the School Community
Describe how your nominee POSITIVELY influences school community, FOSTERS a safe
and positive school environment, and INITIATES improvements in school programs and
services.
23. Outstanding Communicators
Describe how your nominee COMMUNICATES effectively with students, COLLABORATES
with other staff, and REPRESENTS the interests of the school and district.
Skip to question 28.
Volunteers
Complete a narrative for each criteria.
24. Inspires Students to Reach Their Full Potential
Describe how your nominee SUPPORTS student needs, ENCOURAGES students to learn
and enjoy their learning, and ENHANCES the quality of student experiences.
https://docs.google.com/forms/d/1ORYwUiPWRXDm_1g7u6VC9zBMuZfCxtvSLw­LN9HVtfk/edit?usp=drive_web
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Champions for Excellence in Teaching and Learning Award
25. Commitment to the Team
Describe how your nominee PROVIDES inspiration and mentorship, DEMONSTRATES
dedication to school and district needs, BRINGS personal skills and experience to enhance
the team.
26. Supports the School Community
Describe how your nominee PROVIDES consistent resources/time, ADDRESSES
significant needs of the school, and BRIDGES the school and larger community.
27. Key Communicator
Describe how your nominee SHARES stories and experiences that positively impact
students, RELATES to students and staff, and BRINGS community voice to the school and
district.
Skip to question 28.
Additional Information Required
Please provide the following additional information.
28. Share a story or anecdote about the nominee that demonstrates how the individual
embodies the qualities specified for this or her category.
https://docs.google.com/forms/d/1ORYwUiPWRXDm_1g7u6VC9zBMuZfCxtvSLw­LN9HVtfk/edit?usp=drive_web
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29. Nomination Submitted By: *
First Name
30. Last Name *
31. Email Address: *
32. Home Address:
33. City, State, Zip
34. Phone Number: *
35. Alternate Phone Number:
Supporting Documentation
Please provide one letter of support written by someone from one of the following groups: parent, student, colleague, business or community member. Ideally, this letter would represent a different perspective than that of the nominator. It should be no more than one standard page and emailed to CCSA@dpi.nc.gov no later than 5:00 p.m. on Sunday, January 31, 2016.
Thank You for Submitting Your Nomination!
Nominations will be accepted for all categories. A selection committee of DPI staff and educators will review each nomination. Winners will be announced at the Wednesday, March 23 CCSA closing (awards) general session. Each nominee receives complimentary admission to the closing session. Additional admissions to the awards can be purchased for $40 per person.
Please note: Be sure to submit all requested information for your nomination to ccsa@dpi.nc.gov by 5:00 p.m. on Sunday, January 31, 2016. It is the responsibility of the nominator to ensure that the nomination form is submitted completely and accurately. Nominations providing incomplete information will not be considered. Winners will be notified by February 23, 2016.
If you have questions, please contact:
CCSA Champions Awards
North Carolina Department of Public Instruction
6368 Mail Service Center
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12/18/2015
Champions for Excellence in Teaching and Learning Award
Raleigh, 27699­6368
Phone: (919) 807­3639
Fax: (919) 807­4065
ccsa@dpi.nc.gov
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