Trailblazer Nomination Form
The Trailblazer Award is awarded to those who have shown resilience and courage in forging the path for others in personalized learning; those that embody the Trailblazer Spirit (http://bit.ly/25nA2Ip). Individuals, teams, programs, schools, districts, or organizations are eligible to be nominated and receive the award.

The award is given at the Annual Personalized Learning Convening in Milwaukee, WI. Nominations are reviewed by the Institute's Advisory Committee.

Nomination forms are due by 5 PM CT on September 11, 2017.

If you have any questions, please contact: contactus@institute4pl.org or call Carolyn 262-787-9500 x9572

Nominee's Information
Information on the person you are nominating. If you are nominating a group of people, please provide the program or school name in the "name" field as well as a primary contact.
Name:
Your answer
Email Address:
Your answer
Position/Grade Level/Subject(s) taught:
Your answer
School District:
Your answer
School:
Your answer
Address:
Your answer
City:
Your answer
State:
Your answer
Zip Code:
Your answer
Length of time engaged with personalized learning:
Your answer
Type of Trailblazer
This year we are asking nominees to be grouped as leaders or practitioners of personalized learning, recognizing that trailblazing as a district or school leader vs. a teacher or teacher leader will look different.
Please review the scoring rubric before submitting your answers: http://bit.ly/2pWFCRX
How has this person (or group) embodied the Trailblazer Spirit?
Your answer
Please provide a perspective or reaction from a learner about this individual or group:
Your answer
Optional: Video/Artifact Submission
If possible, submit a link to a video or artifact that embodies the work of this educator so the reviewing committee can see them in action
Your answer
Nominator's Information
Your information
Name:
Your answer
Email Address:
Your answer
School District/Organization:
Your answer
School:
Your answer
Address:
Your answer
City:
Your answer
State:
Your answer
Zip Code:
Your answer
How do you know the nominee?
You can nominate yourself too!
Your answer
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