Colorado Online/Blended Teacher and School Counselor Recognition Nomination Form

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1 Colorado Online/Blended Teacher and School Counselor Recognition Nomination Form Submit completed nominations via to: Due: Friday March 20, 2015 by 4:00PM

2 Dear Directors, Principals and Superintendents: The Division of Innovation, Choice and Engagement at the Colorado Department of Education would like to honor teachers and school counselors across the State who have demonstrated exemplary service to students enrolled in Colorado s online & blended schools and programs. Teacher candidates will be chosen based on student performance, teacher-student interaction, and innovative methods of technology usage and/or instructional delivery in an online/blended environment. School counselor candidates will be chosen based on their success in supporting post-secondary academic, and workforce readiness in their online/blended students. The CDE review team will evaluate the evidence presented in the application and self-response form regarding the impact candidates have had on student outcomes using the attached rubrics, both of which were informed by State and national standards for quality online schools, including the inacol National Standards for Quality Online Teaching. If you would like to nominate a teacher or school counselor, please fill out the attached application and submit it to the Colorado Department of Education by Friday, March 20, 2015 at 4:00PM. Each teacher or school counselor nominated must also fill out a Candidate Self-Response form and provide a picture of themselves. The teachers and counselors that are chosen will have their pictures, along with excerpts of their responses, posted on the CDE website and recognition will be announced on the CDE Blended & Online Learning ListServ. The finalists and their service to Colorado online/blended students will also be recognized at the Mayl State Board Meeting. We are excited to celebrate the practitioners in your schools who have gone above and beyond to meet the needs of students and play a primary role in their academic success. Thank you for taking the time to nominate them. Sincerely, Rebecca Holmes Associate Commisioner Innovation, Choice and Engagement Division Candidate Eligibility Worked for a Supplemental, Single-District, or Multi-District Online Program in Colorado in the and school years. Licensed and/or considered highly qualified as defined by the No Child Left Behind (NCLB) Act.

3 Nomination Form Candidate s Contact Information Teacher/Counselor Nominee Teacher Counselor School/Program Name Authorizing District School/Program Address City State Zip Telephone Name of person submitting nomination Title Employer Phone Number Signature Date

4 Teacher Recognition Please Note: The following questions are to be answered by the Director, Principal or Superintendent nominating the candidate. Responses should not exceed 300 words each. 1. Why are you nominating this candidate? What sets her/him apart from others in the field? 2. Please demonstrate evidence of the candidate s positive impact on student performance, including academic achievement and/or growth. 3. How does the candidate differentiate instruction and utilize intervention strategies to meet the needs of individual students and what result has this had on student outcomes? 4. How has the candidate successfully built a working relationship with students resulting in active participation, consistent attendance, and student growth? 5. Please describe innovative ways in which the candidate effectively uses technology for communication, productivity, collaboration, analysis, presentation, research, and online content delivery. 6. Are there any other exceptional strengths or skills for which the candidate deserves recognition?

5 School Counselor Recognition Please Note: The following questions are to be answered by the Director, Principal or Superintendent nominating the candidate. Responses should not exceed 300 words each. 1. Why are you nominating this candidate? What sets her/him apart from others in the field? 2. How does the candidate support student acquisition of the academic knowledge and skills that contribute to effective learning in school and adequate preparation for post-secondary settings? 3. How has the candidate successfully built a working relationship with students resulting in positive outcomes for students (e.g, active participation, consistent attendance, completion, student growth)? 4. How does the candidate help students develop strategies to achieve future academic and career goals? 5. Please describe innovative ways in which the candidate effectively uses technology for communication, productivity, collaboration, analysis, presentation, research, or student support. 6. Are there any other exceptional strengths or skills for which the candidate deserves recognition?