Trustworthiness u Respect u Responsibility u Fairness u Caring u Citizenship
2014-2015 Teacher of Character Nomination Form
"A person of character Is a good person, someone to look up to and admire, who knows the
difference between right and wrong, who always tries to do what is right, who
sets a good example for everyone and makes the world a better place."
Do you know a current classroom teacher who has a true passion for teaching? One who makes a positive impact
on the lives of our children? An educator who quenches a child’s thirst for knowledge while reinforcing the six pillars
of Character? CHARACTER COUNTS! in Chaves County is proud to team up with Read & Stevens Inc. to honor
our top educators with the Teacher of Character Award.
Deadline for Submissions: January 30 th, 2015
Please complete this form. All requested information must be provided for the nominee to be considered
for this award. Nominations will not be accepted from immediate family of nominee. CHARACTER
COUNTS! in Chaves County and Read & Stevens Inc. and their families are not eligible to nominate or
receive this award. No previous Gold or Silver winners are eligible to repeat. All submissions must be
limited to the space provided. Only what is written on space provided will be given consideration
during the judging process.
Completed applications can be submitted via mail, delivery to the following:
School
Bring the completed form back to the school office.
Mailing Address:
Character Counts! In Chaves County
PO Box 999
Roswell, NM 88202-0999
Deliver To:
Roswell Chamber of Commerce
131 W. 2nd Street, Roswell
Electronic nominations forms are available at the Character Counts web site at: www.ccccnm.org
Teacher of Character Awards
All eligible nominees will be considered for the Teacher of Character Award and all will be recognized at
an awards banquet being held on March 3rd , 2015. The prize structure this year is contingent upon
sponsor support. Award Finalist categories include:
-1Gold Award
- 3 Silver Awards
- 10 Bronze Awards
Award Reception: March 3, 2015, 6-8pm
You and a guest, and your nominee and their guest are invited to attend the Award Reception at the
Roswell Civic Center on March 3, 2015. Enjoy an evening of entertainment, hors d’oeuvres ,and
celebration.
Contact Us
For questions, more information, or to request a nomination form in Spanish, please contact us at:
Tim Fuller, CHARACTER COUNTS! in Chaves County, 575-626-4495, timfuller@plateautel.net
Nominations are due by Friday, January 30th, 2015.
Trustworthiness u
Respect u
Responsibility u
Fairness u Caring u
Citizenship
NOMINEE INFORMATION
Mr/Ms/Mrs Teacher’s First Name:____________________ Last Name:___________________________
School:_____________________________________________ Principal/Director:__________________
Subject(s):__________________________________________ Grade Taught:_____________________
Please select one:
r Preschool r Elementary School r Middle School r High school r College
NOMINATOR INFORMATION
Mr/Ms/Mrs First Name_________________________ Last Name:_______________________________
Affiliation with Nominee: ________________________________________________________________
Your Mailing Address: __________________________ City:______________ State:___ Zip:__________
Daytime Phone/Fax: (____)_______________/_______________ E-mail:__________________________
NOMINATION:
For each Pillar of Character, give an example of how the nominee incorporates it into his/her classroom.
Print legibly. No pencil, blue or black ink only. Only what is written on space provided will be given
consideration during the judging process.
TRUSTWORTHINESS:
____________________________________________________________________________________
____________________________________________________________________________________
RESPECT:
____________________________________________________________________________________
____________________________________________________________________________________
RESPONSIBILITY:
____________________________________________________________________________________
____________________________________________________________________________________
FAIRNESS:
____________________________________________________________________________________
____________________________________________________________________________________
CARING:
____________________________________________________________________________________
____________________________________________________________________________________
CITIZENSHIP:
____________________________________________________________________________________
____________________________________________________________________________________
Give recent, specific examples or relate an incident of how this nominee positively impacted you
personally:
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
____________________________________________________________________________________
Your signature:_______________________________________ Date:______________________
Nominations are due by January 30th, 2015