Nomination Form

Name of teacher being nominated:

Teacher Information

School or Center:

School Address:

School City, State, Zip:

School Phone:

Classroom Phone:

School Fax:

Home Address:

Home City, State, Zip:

Home Phone:

Home Fax:

E-Mail Address:

Nominator Information

Name of Nominator:

Nominator E-Mail

Nominator Work Phone:

Nominator Home Phone:

Nominator Cell Phone:

Nominator Fax:

Your relationship with the teacher:

Below check all that currently apply to the teacher you are nominating:

Type of Program

State Pre-K

Head Start Program

Child Care Center

Preschool

Family Child Care Home

Primary (K-3)

Age/Grade Level

Infants (under 15 mos.)

Toddlers (15-24 mos.)

Two-year-olds (24-36 mos.)

Preschoolers (3-5 years)

Kindergarten

First Grade

Second Grade

Third Grade

Setting

Public

Private

Religious

Community Agency

Special Education

Essay

Please write and attach an essay of between 700 and 800 words that explains how your nominee demonstrates his or her adherence to the five Kohl McCormick Selection Criteria: Dedication, innovation, leadership, respect for children and families, and commitment to professional growth.

ELIGIBILITY

Candidate must:

be employed and working directly with children birth through age eight a minimum of 30 hours per week in a public, private, or parochial school, preschool, childcare center, Head Start program, or licensed family child care home.
have completed a minimum of five full years as an early childhood teacher by the beginning of the 2007-08 school year.
work in Cook County, Illinois, or DuPage County, Illinois.
sign a certificate of agreement to actively participate in Academy activities if a winner.
must be articulate and possess the ability to communicate with major Chicagoland media outlets in order to expand public awareness of the importance of early childhood education and present to Chicagoland educators at Academy-led professional growth workshops

The following individuals are not eligible:

Teaching assistants, resource teachers, speech therapists, librarians, and counselors

Any teacher who is at a school/center of a teacher who was a winner last year

Relatives or employees of the Dolores Kohl Education Foundation, the Kohl McCormick StoryBus, the Kohl Children's Museum of Greater Chicago, and the McCormick Tribune Foundation or any of its affiliates

Please submit nomination forms by Wednesday, October 29, 2008