North Carolina Jaycees

NORTH CAROLINA JAYCEES 2013 Outstanding Young Educator Nomination Form

The purpose of the Outstanding Young Educator program is to foster better relations through Jaycee-educator contacts and by creating a greater public interest in and understanding of today's educator.

Nominee Qualifications 1. Nominee must be between the ages of 21 and 40 as of January 1, 2013. 2. The nominee may be male or female and need not be affiliated with the Jaycees. 3. Be a professional educator. Must be employed no lower than kindergarten or higher than the 12th grade.

Requirements for Nomination 1. Nominee must complete information and questions on this form. (Additional sheets may be attached). Use black ink or type. 2. Nominee must sign the form on page 3. 3. A nomination letter/statement from your supervisor must be included with this form. 4. Nomination form and attachments must be submitted to the local Jaycee chapter by April 6, 2013.

Chapter mailing address: Raleigh Jaycees (Attn: 2013 DSA), P.O. Box 20244, Raleigh, NC 27619. Must be postmarked on or before 4/6/13. Chapter email address: Email to [email protected] by 11:59 pm on 4/6/13.

Background Information Nominee Name: Birth date: Age: Address: City/State/Zip: Home Phone: Business Phone: Marital Status: Spouse's Name: Children (Name/Ages): Employer: School: High School Attended: Year Graduated:

College Or University Major Minor Degree Year of Degree

Military Service (Branch/Service Dates/Rank):

Professional Background (10 points) 1. List teaching positions held, with dates (include present position).

1 2. List teaching certificates held and dates issued.

3. List graduate work, workshops and conferences attended since being certified to teach. (Give dates and length of time attended). 4. Indicate scholarships, grants, and other funds received while completing preparatory work.

5. List Academic honors received.

6. What type of employment do you have during summer months?

Teaching Skills (50 points) 1. Indicate methods used to maintain classroom control.

2. Describe how you provide an atmosphere that encourages learning.

3. Describe how you evaluate students' progress and growth.

4. How do you plan your teaching to achieve maximum effectiveness?

5. How do you broaden and enrich the subject matter?

6. How do you provide for individual differences?

7. Cite examples of ways you have attempted to improve your teaching.

8. How do you help students by individual counseling and by other methods as they need help? Explain.

9. From which phase of your teaching do you derive the most self-satisfaction? Explain.

10. List examples of ways you evaluate your teaching.

11. What, in your opinion, is your strongest characteristic as a teacher?

12. What, in your opinion, is your weakest characteristic as a teacher? What are you doing to correct this?

Contributions to Profession, Community, State and Nation (40 points) 1. Indicate membership and offices held (professional, church, civic, fraternal and governmental organizations).

2. What services have you rendered to the teaching profession outside of your classroom duties?

3. What services aside from teaching have you rendered to your community?

Nominee Signature I certify that, to the best of my knowledge and belief, the statements given truly represent my background and activities. I give permission for the facts to be used in publication. 2 Signature of Nominee ______

LOCAL CHAIRMAN ONLY Deadline for receipt of entries to state competition is April 17, 2013. Please email nomination form and attachments to [email protected]. Entry fee of $5 can be mailed to NC Jaycees 6300 Creedmoor Road, Suite 170 #257 Raleigh, NC 27612 or paid using Paypal via the NCJC State Website.

I certify that the above name is of the duly selected nominee of the Jaycees and is our official entry in the North Carolina Jaycees State Competition.

Chapter President: Address: Phone: Signature of Chapter President ______

Will Nominee be available to attend the State Awards Banquet on May 4, 2013? Yes No