CLTA AWARDS 2009 Nomination Form

Hal Wingard Lifetime Achievement Award (Scoring criteria)

 Be sure to review the scoring criteria in preparation for submitting this Nomination Form

 Nominee (PLEASE PRINT)

Name _____________________________________________________

E-mail _________________________________________________________________

Home Address ______________________________City__________________ , CA , ZIP__________

Home Phone (________)_____________________ Work Phone (________)_____________________

Subjects Taught ______________________________________________________

District Name _________________________________________________________

School Name _________________________________________________________

Name of District Superintendent ___________________________________________

Principal ____________________________________________________________

School Address _________________________________City__________________ ,CA , ZIP_______________

 Supporting Documents Use the checklist below to indicate which documents accompany this nomination form.

___ evidence that the applicant has been a member of CLTA for 2 years, this year and preceding. You can get E-mail confirmation from membership chair Marge Sotomayor, mjsotomayorsuddenlink.net.

___ letter of nomination (original + three copies) describing attributes and contributions

___ nominated by any CLTA member including CLTA board members

___ completed nomination form

___ brief professional resumé (original + three copies)

___ a recent photograph (one copy suitable for display)

___ three letters of recommendation (original + three copies of each) from persons below:

1) Name and Position_____________________________________________Phone____________________

2) Name and Position_____________________________________________Phone____________________

3) Name and Position_____________________________________________Phone____________________

You may want to provide those who write letters of recommendation with the scoring rubric.

NOMINATOR (PLEASE PRINT)

Name and Position ___________________________________________________________

Address ____________________________________________ City ___________________ ZIP _____________

Phone (_______)____________________________ Email _____________________________________________

Nominating Organization (if applicable) _____________________________

Postmark Deadline: January 5, 2009 SEND NOMINATIONS/APPLICATIONS TO

Lewis Johnson, Awards Committee Chairperson

13119 Tawya Road

Apple Valley, CA 92308

For awards questions, contact Lewis Johnson at lewisjohnsoncharter.net or (760) 953-0659 (e-mail preferred).