Alumni & Friends
950 Main Street • Worcester, MA 01610
Tel: 508 793 7166 •

Outstanding Secondary Educator Award

The Clark University Alumni Association

All nominations must be received in the Alumni Affairs Office by Wednesday, March 11, 2009. All fields are required.

Nominee Information:
Name of Teacher You Are Nominating:
Subject(s) Taught:
School Name:
School Address:
City:
State:
Zip Code:
School Principal or Headmaster:
School Phone Number:
Name of Teacher's Hometown Newspaper:
Name of Your Hometown Newspaper:
Information About You:
Your Name:
Campus Box Number:
Campus Phone Number:
E-Mail Address:
Home Address: (if not on campus)
Interview Times:
Select your preferred interview times for Sunday, March 30:
First Choice:
Second Choice:
Third Choice:
	I need to talk to someone about scheduling a different time for an interview.
How was this teacher outstanding?

How did this teacher influence your educational and personal goals?