The 2012-2013

1. The 2012-2013 Educator Nomination Form A campaign to honor and support Teachers, Administrators, and Support Staff KSCJ, KSUX, Burger King, and the other participating business sponsors are again pleased to be honoring those teachers, administrators, and school staff who have made outstanding contributions to the education and lives of our communities’ young people with our Educator program. Each month, one educator is selected from the nominations to receive the monthly award and prizes from our sponsors – including a $50 gift card from the Education Station, a plaque from Five Star Awards, coupons from Burger King, and a celebration breakfast from Perkins. Each of our monthly winners is then entered into the Educator of the Year nominations. Our Educator of the Year wins a Grand Prize of $1000 from Robert W. Baird Wealth Management office in Sioux City for use in their school. McClintock Insurance

2. Please use this form for nominating an Educator of the Month .This person may be a teacher, administrator or school staff person. Nominee’s Name___________________________________________ Nominee’s School __________________________________________ Nominee’s Position _________________________________________ Nominee’s School Phone Number ______________________________ Main Reason for Nomination __________________________________ Nominated By _____________________________________________ In 200 words or less provide more details on the contributions made by nominee to merit this award __________________________________  _________________________________________________________ _________________________________________________________  ____________________________________________________________________________________________________________________________________________________________________________ (Use back of form if necessary or attach another sheet) Return Form To: KSCJ/KSUX, 2000 Indian Hills Drive, Sioux City, IA 51104 or FAX to 712-239-3346 by the 20th of each month.