Microsoft Word - 2016 Exemplary Leader.doc

2016 Official Nomination Form Exemplary Leadership Award Presented by the Buckeye Association of School Administrators CRITERIA: The BASA Exemplary Leadership Award will be presented to an active member in each BASA region who has demonstrated outstanding educational leadership in making significant contributions to educational administration in a school district, education service center or educational institution. The candidate is required to have a minimum of three years of continuous service as an administrator or college instructor and to have been a BASA member for a minimum of three years. PROCEDURE: A selection committee has been appointed by the regional director within each of the following BASA regions. Any individual may nominate him/her self or someone else for this award. Nominations will be accepted in the following BASA Regions Please submit your nominations to your Regional Director by September 7, 2016 This official nomination form for the Exemplary Leadership Award must be submitted to your regional director listed below by September 7, 2016 Please see the map on reverse if you are unsure of your region. The awards will be presented at the BASA Fall Conference.

REGIONAL DIRECTORS

Region 1

Director:

Jim Fritz, Anthony Local Schools jfritz@anthonywayneschools.org Greg Denecker, Bluffton EVS deneckerg@blufftonschools.org Michael Sheppard msheppard@berea.k12.oh.us Richard Hall, Mid-East Career Center rhall@mideastctc.org Doug Ute, Newark City Schools dute@laca.org

Region 2

Director:

Region 3

Director:

Region 7

Director:

Region 8

Director:

Region 9

Director:

Susan Gunnell, Huber Heights City Schools susan.gunnell@huberheightscityschools.org James Metcalf, Plyjmouth Shiloh Local Schools metcalf.jim@plymouth.k12.oh.us

Region 10

Director:

BASA REGIONS

Exemplary Leadership Award Official Nomination Form

Deadline: September 7, 2016

Please type or print legibly Name: _______________________________________________________________________ BASA Member?  Yes  No Years of continuous service _____________ Position ____________________________________________________________________ Organization ________________________________________________________________ Address ____________________________________________________________________ City___________________________________State__________ Zip ___________________ Telephone______________________________Fax _________________________________ Dates ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Other positions held during the past five years: Position Organization

I. Description of significant contributions/exemplary leadership:

Statement describing how you or the nominated candidate actually enhanced education through exemplary leadership:

Submitted by (please print name) ________________________________________ Signature ________________________________________ Title ________________________________________ Date ________________________________________

Please return to your Regional Director listed on page 1 by September 7, 2016