Trustworthiness u Respect u Responsibility u Fairness u Caring u Citizenship

1. Trustworthiness u Respect u Responsibility u Fairness u Caring u Citizenship 2013-2014 Teacher of Character Nomination Form "A person of character Is a good person, someone to look up to and admire, who knows the difference between right and wrong, who always tries to do what is right, who sets a good example for everyone and makes the world a better place." Do you know a current classroom teacher who has a true passion for teaching? One who makes a positive impact on the lives of our children? An educator who quenches a child’s thirst for knowledge while reinforcing the six pillars of Character? CHARACTER COUNTS! in Chaves County is proud to team up with Read & Stevens Inc. to honor our top educators with the Teacher of Character Award. Deadline for Submissions: January 31st, 2014 Please complete this form. All requested information must be provided for the nominee to be considered for this award. Nominations will not be accepted from immediate family of nominee. CHARACTER COUNTS! in Chaves County and Read & Stevens Inc. and their families are not eligible to nominate or receive this award. No previous Gold or Silver winners are eligible to repeat. All submissions must be limited to the space provided. Only what is written on space provided will be given consideration during the judging process. Completed applications can be submitted via mail, delivery to the following: School Bring the completed form back to the school office. Mailing Address: Character Counts! In Chaves County PO Box 999 Roswell, NM 88202-0999 Deliver To: Roswell Chamber of Commerce 131 W. 2nd Street, Roswell Electronic nominations forms are available at the Character Counts web site at: www.ccccnm.org Teacher of Character Awards All eligible nominees will be considered for the Teacher of Character Award and all will be recognized at an awards banquet being held on March 4th , 2014. The prize structure this year is contingent upon sponsor support. Award Finalist categories include: -1Gold Award - 3 Silver Awards - 10 Bronze Awards Award Reception: March 4, 2014, 6-8pm You and a guest, and your nominee and their guest are invited to attend the Award Reception at the Roswell Civic Center on March 4, 2014. Enjoy an evening of entertainment, hors d’oeuvres ,and celebration. Contact Us For questions, more information, or to request a nomination form in Spanish, please contact us at: Tim Fuller, CHARACTER COUNTS! in Chaves County, 575-626-4495, timfuller@plateautel.net Nominations are due by Friday, January 31st, 2014.

2. Trustworthiness u Respect u Responsibility u Fairness u Caring u Citizenship NOMINEE INFORMATION Mr/Ms/Mrs Teacher’s First Name:____________________ Last Name:___________________________ School:_____________________________________________ Principal/Director:__________________ Subject(s):__________________________________________ Grade Taught:_____________________ Please select one: r Preschool r Elementary School r Middle School r High school r College NOMINATOR INFORMATION Mr/Ms/Mrs First Name_________________________ Last Name:_______________________________ Affiliation with Nominee: ________________________________________________________________ Your Mailing Address: __________________________ City:______________ State:___ Zip:__________ Daytime Phone/Fax: (____)_______________/_______________ E-mail:__________________________ NOMINATION: For each Pillar of Character, give an example of how the nominee incorporates it into his/her classroom. Print legibly. No pencil, blue or black ink only. Only what is written on space provided will be given consideration during the judging process. TRUSTWORTHINESS: ________________________________________________________________________________________________________________________________________________________________________ RESPECT: ________________________________________________________________________________________________________________________________________________________________________ RESPONSIBILITY: ________________________________________________________________________________________________________________________________________________________________________ FAIRNESS: ________________________________________________________________________________________________________________________________________________________________________ CARING: ________________________________________________________________________________________________________________________________________________________________________ CITIZENSHIP: ________________________________________________________________________________________________________________________________________________________________________ Give recent, specific examples or relate an incident of how this nominee positively impacted you personally: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ Your signature:_______________________________________ Date:______________________ Nominations are due by January 31st, 2014