Outstanding Faculty/Academic Staff Teaching Award Nomination Form

Name of Nominee:

Name of Individual Making the Nomination:

Phone Number:

Email:

Organization Affiliation of Individual Making the Nomination:

Selection Criteria:

1. Impact on and concern for students
2. Mentorship
3. Involvement with student groups
4. Classroom environment

Please use the space below to form a detailed explanation as to how your nominee’s involvement has influenced your organization and presently enrolled students along with any other information you would like to share in 250 words or less

If you have any supporting documents, please send them as a PDF to campusawards@uww.edu. Please include the award and your name in the subject line.

Please submit and return all award materials no later than 4:00 pm on Friday, April 2, 2010.