The MIT Alumni Association Inspirational Teacher Award

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Most of us have had a high school teacher, counselor, or coach who stands out in our hearts and memories as a significant influence in our lives. The lessons such outstanding educators teach often go far beyond the subject matter of their fields. They may instill values and a love of learning that shape our educational and career choices, and guide us well throughout our adult lives. MIT wishes to recognize a few of the exceptional high school educators who have influenced the lives of our students. Selections will be made on the basis of information and insights presented on this nomination.

This application form must be submitted by Friday, November 30, 2012.

Nomination Information
MIT Student's First Name
Last Name
Email
MIT Course Number	Year

Local Address

City, State, Zip

Permanent Address

City, State, Zip

Local Telephone

Your Nominee
Title:
First Name
Last Name
Teacher's Email Address

Subject(s) taught or position held
School's Name
Principal's Name
Principal's Email
School's Address
School's City, State, Zip
School's URL

Does your nominee still work at the school?	Yes No Unsure
If no, can you give the educator's present professional location:

Telephone
To the best of your knowledge, is this teacher recognized as an outstanding educator and person of good character by other students and colleagues? Yes No Comments: (300 characters max)

In honoring the high school educators who are selected, may we quote from your statements in this nomination and mention you by name? Yes No
Would you be willing/able to produce a short video on your nominee? Yes No
Please complete the following sections of the questionnaire in your own words. It is helpful for the selection committee when responses are as specific as possible, reinforcing your praise and comments with real-life examples that reflect the educator's qualities and character. Please limit your responses to ~150 words.
What is the primary reason for your choosing this educator to be your nominee? (1000 characters max)

Are there additional reasons why you think this educator is appropriate for this award? If so, please describe briefly. (1000 characters max)

Describe the ways in which this educator has had a positive impact on your life, inspiring you to strive for excellence and overcome challenges; consider the successes you have enjoyed here at MIT. (1000 characters max)

Please describe a situation in which you remember observing this educator demonstrating characteristics that you feel are the hallmarks of an outstanding educator. (1000 characters max)

In a brief paragraph, write a "thank you" message to this educator, expressing your gratitude for the ways in which he or she has influenced your life. (1000 characters max)

Optional: Please provide any additional comments about your teacher or the benefits that you see this award providing to your teacher or school. (1000 characters max).

Thank you for your cooperation! SUBMIT BY: Friday, November 30, 2012