Kansas Music Educators Association

Northwest District

Outstanding Music Teacher

Application Form

Please Type

Nominated Teacher________________________________________________

School Name_____________________________________________________

KMEA District_______                            Total Years in Profession____________

                School Address                                                    Home Address

Street_____________________________    Street_________________________

City______________________________     City__________________________

State_______   Zip________________          State________  Zip___________

Telephone______________________            Telephone___________________

Teaching Level

__Elementary    __Middle Level    __Secondary    __College or University

Subject Taught

__Vocal    __Orchestra    __Band    __General    __Private    __Other

References Needed

        1) Peer_______________________________ City______________________

        2) Parent______________________________ City______________________

        3) Administrator_________________________ City______________________

Qualifications

        1) Must have been in teaching for at least ten years.

        2) Must be a member of KMEA.

        3) Program must have shown improvement and/or consistency over the years.

        4) Nominations may be made by teachers, administrators, or parents.

    Please submit this form to the Past President by August 1 for the following school year.