<p> Golden Apple Award</p><p>Teacher’s Application Form</p><p>Nominee Information</p><p>Congratulations!</p><p>You have been nominated for a Golden Apple Award. Please complete this 6-page form and make 5 complete copies; then return them to your principal by February 13 , 2015. </p><p>Your Name: Date: </p><p>Address:</p><p>Parish: </p><p>School Information</p><p>Name and address of the school in which you presently teach: </p><p>School or Parish Pastor (Chaplain):</p><p>Name of Nominator:</p><p>( ) Parent ( ) Teacher ( ) Parent and Student </p><p>Nominee’s Signature Date</p><p>Application Form for Teacher- Page 1 of 6 Nominee Information Form</p><p>Professional Experience</p><p>Dates School and Location Courses Taught or Start with most recent Position</p><p>Education</p><p>Dates Institution and Degree Start with most recent location</p><p>Application Form for Teacher- Page 2 of 6 Certification Teacher Certification - Elementary and Secondary Teacher, please attach copies of your PA Instructional II certificate and any other certificates earned.</p><p>Catechetical certification – Elementary teachers, please attach a copy of your Basic Catechetical Certificate (or Advanced Catechetical Certificate if it has been earned).</p><p>Secondary School Teachers – Please include below a list of three years of Religion in- services that you have attended (a total of 6).</p><p>Dates Type Areas Start with most recent</p><p>Professional Development (attach copy of PDE Act 48/45 hours)</p><p>Application Form for Teacher – Page 3 of 6 Professional Organizations Indicate any leadership roles and describe any significant involvement.</p><p>Dates Name of Organization Start with most recent</p><p>Service To Church, School, and Community Dates Start with most recent</p><p>Application Form for Teacher– Page 4 of 6</p><p>Awards and Recognitions Dates Start with most recent</p><p>Essay</p><p>As the nominee, you need to submit this essay, in size 14 font with a maximum of 500 words. Essay Topic: “Let us thank all those who teach in Catholic Schools. Educating is an act of love: it is like giving life.” Pope Francis March 1, 2014</p><p>Please describe how your vocation as a Catholic School teacher is an act of love and like giving life? Why do you teach in a Catholic School?</p><p>Application Form for Teacher – Page 5 of 6 Checklist</p><p>Each nominee should be certain to include the following for submission to the principal. The principal will then submit five (5) copies of the packet to Mrs. Livia Riley, Superintendent of Schools.</p><p>Use the checklist below to be certain that your packet is complete.</p><p>1. A completed application form – (Please make certain you have included all required documents.) 2. Nominator Letter – Please include only one nominating letter. Additional letters will not be reviewed. 3. Pastor Letter 4. Principal Letter 5. Nominee Essay</p><p>Application Form for Teacher – Page 6 of 6</p>