VCTM Award Application Cover Sheet

 

Applicants must have taught students at least half time for three years or more.  Teachers may apply any number of times, submitting a new application each time, but an awardee may only win once.

 

Please print your name exactly as you would like it to appear.

 

Name _____________________________  School __________________________

 

Home Address ______________________  School Address ___________________

 

City, State, Zip ______________________  City, State, Zip ____________________

 

Home Phone _______________________  School Phone _____________________

 

Email address___________________________________________

 

Elementary (K-6) _____  Secondary (7-12) _____

 

Elementary teachers:  Are you teaching more than ½ time?_____  If not, please describe your present assignment:__________________________________________________

 

Secondary teachers: Are you teaching math more than ½ time?_____  If not, please describe your present assignment__________________________________________

 

# years teaching experience _____________ 

 

Present grade level ______

 

 

Name of Principal  __________________________________  Phone ______________

 

Name of School District ______________________________

 

Name of Superintendent _____________________________  Phone ______________

 

Superintendent’s Address ________________________________________________