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Teacher of the Month Form
St. Xavier University
Name of person making nomination:
Relationship to nominee:
Subject/Grade of teacher:
City of school:
School phone number:
How has this teacher increased the educational achievements of his/her students in the classroom?
What has this teacher done to make an impact on the community or student body at large?
If applicable, give at least one example of the groundbreaking or innovative teaching strategies this teacher has employed:
Are there any extracurricular activities this teacher has implemented? If so, what are they and what impact have they had on the student body?
List one or two activities that are most important to the teacher nominee and explain why:
Please give at least one example of how the teacher makes a difference in the lives of his/her students:
Are these examples given regarding the teacher still taking place today?
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