ACRES Forms Online

Due: February 15

The American Council on Rural Special Education (ACRES) invites nominations (including self-nominations) for the Outstanding Rural Special Educator Award. This award is given annually to the person selected whose contribution to the field of rural special education exemplifies outstanding work for the benefit of those placed in rural areas. The person so awarded will be a resident of West Virginia for this particular year and will receive the award at the conference.

Visit the ACRES Annual Conference web site.

• For help with the content of this nomination form, please e-mail Lori Garnes at garnesl@minotstateu.edu.
  
• For technical help with this form or to report problems, please e-mail webmaster@acres-sped.org.

Nominator Information

Please enter the following information on yourself, the nominator.

First Name:
Last Name:
Title:
Address:
City:
State:	Choose one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
Bus. Phone:
Home Phone:
E-mail:

Nomination Guidelines

1. The recipient must be an employee in the state in which that year's ACRES annual meeting is held.
2. The recipient must be employed by a rural school or rural school district and could be a paraprofessional, teacher, administrator, or related service provider.
3. The nomination must include the following information:

First Name:
Last Name:
Address:
City:
State:	Choose one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
Bus. Phone:
Home Phone:
E-mail:
Job title:
Employer's name:
Nominee's number of years in current position
Nominee's job description (one paragraph)
Descriptions of the nominee's achievements and contributions to the field of rural special education. This must include a description of the people who benefited and any assistance received by the nominee. (500 words max)

References

Please list the names and addresses of 5 references. References must include at least one person the nominee knows who is a parent of a student in special education, one teacher, and one administrator. Persons identified as references will be contacted by an ACRES representative for additional information.

Reference 1
First Name:
Last Name:
Address:
City:
State:	Choose one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
Phone:
E-mail:
Reference 2
First Name:
Last Name:
Address:
City:
State:	Choose one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
Phone:
E-mail:
Reference 3
First Name:
Last Name:
Address:
City:
State:	Choose one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
Phone:
E-mail:
Reference 4
First Name:
Last Name:
Address:
City:
State:	Choose one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
Phone:
E-mail:
Reference 5
First Name:
Last Name:
Address:
City:
State:	Choose one Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
ZIP:
Phone:
E-mail:

Materials must be received by February 15

Questions? Please contact by e-mail Lori Garnes at garnesl@minotstateu.edu.

NOTE: If you do not receive a success message, or to report other problems, e-mail webmaster@acres-sped.org.