Fifth District Lay Organization

Fifth District Lay Organization Evening of Elegance 2015 Recognition of Educators Application

The Fifth District Lay Organization is proud to recognize educators impacting the church and community. The deadline to nominate an educator is Friday, February 6, 2015 at 11:59 p.m. PST. Winners will be selected no later than Saturday, February 14, 2015. Awards will be presented on Thursday, March 12, 2015 during the Fifth Episcopal District Mid Year Convocation in Los Angeles, California.

Conference presidents must submit applications to [email protected]. Please type applications.

1. Thank you for nominating an educator. Please provide the following information about yourself.

First Name ______Last Name ______

Email ______

How do you know the educator being nominated? _____ I am a student/former student _____ I am a colleague _____ I am a parent of a student _____ I am a family member _____ I am self-nominating _____ Other ______

Why do you feel the educator deserves recognition? ______

______

2. Please provide the following information about the nominee. _____ Mr. _____ Mrs. _____ Ms. _____ Dr.

First Name ______Last Name ______

Email ______

Church ______

Fifth District Lay Organization 2015 Educator Recognition Application Page 1 Church Activities ______

______

Presiding Elder District ______

Annual Conference ______

Conference Lay President ______

3. Please provide the following information about the educational program/school/school district.

Name of Program ______

_____ Youth Program _____ Adult Program

Years in Existence ______

_____ Afternoon program _____ Summer Program

Duration of Program ______

Number of participants served ______

Population served ______

______

Main focus of program

______

Subject areas covered

______

STEM focus

______

Fifth District Lay Organization 2015 Educator Recognition Application Page 2 4. Narrative on demonstrated evidence that the educator has: made a measurable difference in the lives students; made significant and lasting contributions to the field of education; inspired students of all backgrounds and abilities to learn; the respect and admiration of students, parents, and colleagues; significant impact on their church and community. The narrative should be 500 words or less.

______

Fifth District Lay Organization 2015 Educator Recognition Application Page 3 ______

______

End of Application

Fifth District Lay Organization 2015 Educator Recognition Application Page 4