2017 Excellence in Teaching, Learning, and
Service Award Nomination
Cover Sheet
Your nomination statement (double spaced, 12-point font, 2 pages maximum) should describe how the
faculty member being nominated has contributed to the core themes of Seattle Central College and/or
Seattle Vocational Institute in one or more of the areas described below.
How has this instructor:
1. Shown responsive teaching and learning in her/his primary assignment (e.g., classroom
instruction, counseling, or library)?
2. Made a positive impact on students of diverse learning abilities and diverse personal experiences?
3. Shown initiative and courage in being a catalyst for opportunities and success within the campus
communities?
4. Demonstrated outstanding efforts to engage with Seattle Central College/SVI and/or the broader
communities?
From your perspective as either a colleague or student, please describe how this instructor has inspired
students and/or changed lives.
Please use a separate form for each nominee. Submit nomination
statement and cover sheet to: Karyssa Mathison via e-mail
([email protected])
or deliver/mail to her at room/mailstop BE 4180.
I nominate ___________________________________________________________ for the 2017
Excellence in Teaching, Learning and Service Award.
I am submitting this nomination form in good faith and on my own initiative:
Signature: ___________________________________________
Name (printed): _______________________________________
You may 
may not  provide my nomination statement and cover sheet to the nominee.
DEADLINE: 4:00pm on Friday, May 19, 2017
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Office Use:
 Nomination Statement
 Cover Sheet
Received _________________________