NOMINATION FORM Employee’s name:___________________________________ Job title or position: ____________________________________________ Building: __________________________________________________________________________________________________________ Name of nominator:__________________________________ Nominator’s role: ■ student ■ parent ■ staff ■ community member
Criteria 1. Goes the extra mile or exceeds expectations in job duties. 2. Makes an extra effort to support students’ learning and well being. 3. Develops positive relationships with students, families, and/or community. 4. Demonstrates care and concern for students. 5. Develops new ideas to enhance learning, solve problems and/or meet district needs. 6. Brings together ideas and/or resources and/or people to overcome difficulties or challenges. 7. Inspires others to do and be their best. 8. Collaborates with outside resources. 9. Works effectively with people of different races, religions, values, attitudes and customs. Choose four of the above criteria and write a brief statement about each one giving specific examples of how your nominee fits each of your chosen criteria. Each of the four statements should be 100 to 150 words. Your nomination showcases the outstanding qualities of your nominee. When you provide specific, concrete examples showing how your nominee meets four of the Above & Beyond nominee criteria, you give the selection committee a picture of his or her exemplary work. You may answer on a separate sheet of paper and attach it to this form. Your name: ________________________________________________________________________________________________ Your address:___________________________________ City:_________________________ Zip code: ____________________ Your phone number(s): _____________________________________
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Your signature: ______________________________________________________________________________________________ May we inform the employee that you have nominated him/her? ■ Yes
■ No
Deadline for nominations is Friday, Jan. 20, 2017. Completed nominations can be emailed to:
[email protected]. For more information, email:
[email protected]. Awards will be Wednesday, April 12.
Completed nominations printed on paper can be mailed to: Above & Beyond Attn: Communication and Public Relations Anoka-Hennepin Educational Service Center 2727 Ferry St. N., Anoka, MN 55303 continued on next page
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