<p> Fifth District Lay Organization Evening of Elegance 2015 Recognition of Educators Application</p><p>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.</p><p>Conference presidents must submit applications to [email protected]. Please type applications.</p><p>1. Thank you for nominating an educator. Please provide the following information about yourself.</p><p>First Name ______Last Name ______</p><p>Email ______</p><p>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 ______</p><p>Why do you feel the educator deserves recognition? ______</p><p>______</p><p>______</p><p>2. Please provide the following information about the nominee. _____ Mr. _____ Mrs. _____ Ms. _____ Dr. </p><p>First Name ______Last Name ______</p><p>Email ______</p><p>Church ______</p><p>Fifth District Lay Organization 2015 Educator Recognition Application Page 1 Church Activities ______</p><p>______</p><p>Presiding Elder District ______</p><p>Annual Conference ______</p><p>Conference Lay President ______</p><p>3. Please provide the following information about the educational program/school/school district. </p><p>Name of Program ______</p><p>_____ Youth Program _____ Adult Program</p><p>Years in Existence ______</p><p>_____ Afternoon program _____ Summer Program</p><p>Duration of Program ______</p><p>Number of participants served ______</p><p>Population served ______</p><p>______</p><p>Main focus of program</p><p>______</p><p>______</p><p>Subject areas covered</p><p>______</p><p>______</p><p>STEM focus</p><p>______</p><p>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.</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>Fifth District Lay Organization 2015 Educator Recognition Application Page 3 ______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>______</p><p>End of Application</p><p>Fifth District Lay Organization 2015 Educator Recognition Application Page 4</p>