Exemplary Awards Nomination Form

All nominations must be supported by the principal or supervisor of the nominee.*

Note - Supervisors also receive a copy of this nomination after it is submitted.

Yes, this nomination is supported by the nominee's supervisor or school principal.

Supervisor / Principal Name*

First Last

Your Name*

First Last

Email*

Phone*

I would like to nominate:*

First Last

School or Location:*

for the:*

Exemplary Contractor Services Award
Exemplary Community Partner Award
Exemplary Parent Volunteer Award
Exemplary Support Services Award
Exemplary Teacher Award

I have verified that the nominee has a minumum of three years teaching experience with Pembina Hills and has not received this award before.*

Yes

I have verified that the nominee has a minumum of three years experience with Pembina Hills and has not received this award before.*

Yes

I have verified that the nominee has a minumum of two years volunteer experience at a Pembina Hills school and has not received this award before.*

Yes

I have verified that the nominee has a minimum of two years’ involvement with a Pembina Hills school, and has not received this award before.*

Yes

Years of Service*

Please indicate the number of years the nominee has volunteered, worked for, or been involved with Pembina Hills. If you are unsure, please check with your school administrator, supervisor, or human resources.

Demonstrates initiative*

Please provide details

Demonstrates initiative to assist students in reaching their full potential.*

Please provide details

Goes the extra mile for students and colleagues.*

Please provide details

Goes the extra mile for students and staff.*

Please provide details

Goes the extra mile for students, the school and the community.*

Please provide details

Goes the extra mile for students, the school and/or school council.*

Please provide details

Has a positive attitude towards students, parents and colleagues.*

Please provide details

Has a positive attitude towards students, parents and schools.*

Please provide details

Is recognized by colleagues and others as an excellent teacher.*

Please provide details of how this person is recognized by staff, colleagues or others

Is recognized by colleagues and others as providing excellent service in his or her field of work.*

Please provide details of how this person is recognized by staff, colleagues or others

Acts as a role model for life-long learning.*

Please provide details

Acts as a positive role model for students.*

Please provide details

Enchances the image and profile of their profession.*

Please provide details

Challenges students to think independently, creatively and critically.*

Please provide details

Contributes to the overall vitality of their school or service area.*

Please provide details

Contributes to the overall vitality of their school.*

Please provide details

Contributes to the overall vitality of their school and community.*

Please provide details

Demonstrates good citizenship*

Please provide details

Briefly describe your relationship to the nominee. Note: You cannot nominate a relative or spouse.*

ie. We work at the same school, their children attend the school I work at, etc.

Other nomination details (optional)

Please use this space to include general comments on how this person contributes to the vitality of their school. As per AP 40-32 3(c) “A nomination does not automatically constitute an award being granted, therefore nominees must not be notified of their nomination.” * Note - do not use images or emojis within this field, as it may cause an error when you submit the form.

Supporting Documents

Please include supporting documents with your nomination. If you have a photo of the nominee you may attach it here.

Drop files here or

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Exemplary Achievement Award Nomination Form