Nominee:

Institution:

Person submitting this form:

Title / Position:

Date:

Nominee has been involved in classroom instruction (including laboratory and discussion sections)
for a minimum of one year (2 semesters or 3 quarters) or the equivalent:    _____  Yes    _____  No.

Nominee is in good academic standing:   _____  Yes    _____  No.

Relative to teachers I know, this nominee ranks (check appropriate boxes below):
 

Criterion	Best	Upper 10%	Upper 25%	Above Average	Below Average
Intellectual impact on students
Intellectual impact on faculty
Scholarship
Concern for students
Professional integrity
Innovations in teaching
Evidences of previous recognition
Recognition by peers off campus
Overall rating as a teacher

Additional remarks (or letter of support):