2017 Southeastern Regional Award For

ACS Division of Chemical Education

2017 Southeastern Regional Award for

Excellence in High School Teaching

Nominee Information Form

Local Section:

Nominee:

Nominator:

DEADLINE: August 15, 2017

July 15, 2016 is the deadline for submitting nominations to the SERMACS 2017 Awards Chair. Please allow sufficient time to meet this deadline. There may be an earlier deadline for local section awards. The nominator should submit all forms electronically to Markus Etzkorn at .

Any individual, except a member of the awards selection committee or a current student of a nominee, may nominate or support a nominee during any given award year.

The Southeastern Regional Award consists of $1000 cash award from the ACS Division of Chemical Education and a plaque. These will be presented at SERMACS 2017 in Charlotte, North Carolina at the Awards Luncheon (TBA).

Nominee Information

Name:
Present Position (Exact Title):
School:
Address:
City:
State and Zip:
Telephone:
Fax (optional):
e-mail:
Website (optional):

·  Give your current teaching assignment including course titles and grade levels.

·  Describe your involvement in extracurricular activities.

·  In the space below (or on a separate sheet), provide a statement of not more than 500 words in which you present your teaching philosophy or otherwise describe your commitment to the profession.

·  Provide a curriculum vita or resume that includes your honors, professional activities, and additional evidence of service to the profession. This must be limited to no more than two (2) pages and the activities listed must have occurred within the past 5 years.

References

A copy of your statement from above and your curriculum vita or resume should be provided to your references for their information. A completed nomination package requires recommendations from:

·  your nominator

·  your current principle or supervisor (if not your nominator)

·  additional optional references for a total of up to three (3)

Principal/supervisor name:

Principle/supervisor e-mail:

Principle/supervisor telephone:

Additional optional reference name:

Optional reference e-mail:

Optional reference telephone:

Additional optional reference name:

Optional reference e-mail:

Optional reference telephone:

Please ask all of your references to use the form entitled "2017 CHED HS Award Reference Form" available on the SERMACS website (http://sermacs.org/awards/teacher.html) and have them send the completed document to your nominator to be submitted with the completed nomination package.