Nomination Form

MAEOP Educational Administrator of the Year

Name of sponsoring association or individual: ___________________________________________

Date of association president or MAEOP member: _______________________________________

Name of association president or member: _____________________________________________

Address of association president or member: ___________________________________________

Full name of candidate: _____________________________________________________________

Employed by: _____________________________________________________________________

Employment address: ______________________________________________________________

Candidate’s immediate supervisor, if any:

Immediate supervisor’s address: _____________________________________________________

List the names and addresses of three persons with whom the nominee works:

1. ___________________________________________________________________________

2. ___________________________________________________________________________

3.____________________________________________________________________________

Reasons for nomination:

Signature of sponsoring association or member: _________________________________________________President or MAEOP member

Please submit five (5) letters of recommendation, a letter from Human Resources Director, and the candidate’s resume.

Return all documents to the Award Committee Chairman shown on page 1 and postmarked by June 30.

Nomination Form

Name of nominee: ________________________________________________________________

II. Previous positions held: Title of Position/Place of Employment/Number of Years ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

III. Education background: Name Of Degrees Received /Location of Institution/ Date Received ___________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

IV. Personal contributions or achievements in the educational field: ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Nomination Form

V. Membership in professional organizations: List the names of professional association(s) of which you are a member.

National: Name Of Organization _ Offices Held____________ Years of Membership ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

State: Name Of Organization _ Offices Held____________ Years of Membership

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Local: Name Of Organization _ Offices Held____________ Years of Membership

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Nomination Form

VI. Offices held and/or committee served on during the past five (5) years:

National: Offices Held /Committees Served On/Years of Membership

State: Offices Held/Committees Served On/Years of Membership ____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Local: Offices Held/Committees Served On/Years of Membership ________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

Note: You may submit additional information on separate enclosures if space on form is insufficient.

Signature of Candidate: ______________________________________Date: _______________