LONNIE & ELAINE
PHILLIPS AWARD
Nomination Form
TFA Award Recipients for 2000
Nominee:
Current Position:
Address:
City:
State:
Zip:
Phone:
Fax:
Email:
Web:
Certified Member
Agency:
Professional
History with the Teaching-Family Model
Provide a
complete chronology of the recipient’s
employment history with the Teaching-Family Model,
positions held, types of populations served, and the
sponsor site affiliation (Use additional pages if
necessary.)
Dates of
Service Population(s) Served Training Agency
Affiliation
____________
__________________________ ______________________
____________
__________________________ ______________________
____________
__________________________ ______________________
____________
__________________________ ______________________
____________
__________________________ ______________________
Certification
History
Provide a copy
of the recipient’s Training/Evaluation
Chronology (from the certified member agency’s
annual report).
Letter of
Nomination
The letter of
nomination accompanying this form should include and/or
address the following:
- The
nature and duration of the nominee’s
service as a Teaching-Family Practitioner(s);
- The
characteristics of residents served by the
Teaching-Family Practitioner;
- The
influence they have had on their residents
and program consumers;
- Their
service to their community, state, and Member
Agency;
- Their
involvement with and contributions to the
Teaching-Family Association;
- The
nominee’s complete chronology of
employment history with the Teaching-Family
Model;
- The
nominee’s current resume; and
- The
names, addresses, and phone numbers of at
least three Teaching-Family members who could
comment on the nominee’s professional
service.
DEADLINE
FOR NOMINATIONS:
Award nominations are being accepted immediately.
Deadline for submission is AUGUST 1, 2001.
PREPARING
THE NOMINATION FOR SUBMISSION:
Print and complete this form, then fax or mail it to
Sarah Yap at the number or address listed below.
SEND
NOMINATIONS TO:
Sarah Yap - Catholic Charities, 200 N. Vineyard, #200,
Honolulu, HI 96817, Phone 808/535-0138, Fax: 808/599-8761
Return
to TFA 2002 Conference Index
page.
This
page was last edited Wednesday, November 13, 2002
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