Nominee:

Institution:

Person submitting this form:

Title / Position:

Date:

Relative to other colleagues with whose teaching abilities and performance I am familiar, I would rate the nominee as follows (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
Evidence of previous recognition
Recognition by peers off-campus
Overall rating as a teacher

Additional remarks (or letter of support):