<h2>2011 Great Teacher Award</h2>
<h3>Nomination Ballot<br /></h3>
<form name="Great-Teacher-Form" enctype="text/plain" action="mailto:kabenne@siue.edu?subject=*2011 Great Teacher Nomination" method="post">
If you have any problems submitting the nomination, please copy, paste and send the form information in an e-mail to <a href="mailto:kabenne@siue.edu">kabenne@siue.edu</a>.
<table border="0" width="500">
<tr>
<td></td>
</tr>
<tr>
<td class="textbodybolda" colspan="2"><br /> Nominator’s Information</td>
</tr>
<tr>
<td width="129" class="text1" align="right">Name</td>
<td width="361"><input name="NAME" size="30" maxlength="30" type="text" id="NAME" /></td>
</tr>
<tr>
<td class="text1" align="right">Phone Number</td>
<td><input name="PHONE" size="30" maxlength="30" type="text" id="PHONE" /></td>
</tr>
<tr>
<td class="text1" align="right">Address</td>
<td><input name="ADDRESS" size="30" maxlength="30" type="text" id="ADDRESS" /></td>
</tr>
<tr>
<td class="text1" align="right">E-mail</td>
<td><input name="EMAIL" size="30" maxlength="30" type="text" id="EMAIL" /></td>
</tr>
<tr>
<td class="text1" align="right">What is Your Relationship with the Professor? (Professor, Advisor, Colleague, etc.)</td>
<td><input name="RELATIONSHIP" size="30" maxlength="30" type="text" id="RELATIONSHIP" /></td>
</tr>
<tr>
<td class="text1" align="right">Graduation Year(s) If Applicable</td>
<td><input name="YEAR-GRADUATED" size="30" maxlength="30" type="text" id="YEAR-GRADUATED" /></td>
</tr>
<tr>
<td class="text1" align="right">Major(s)</td>
<td><input name="MAJOR" size="30" maxlength="30" type="text" id="MAJOR" /></td>
</tr>
<tr>
<td class="textbodybolda" colspan="2">Nominee’s Information</td>
</tr>
<tr>
<td class="text1" align="right">Name</td>
<td><input name="TEACHER-NAME" size="30" maxlength="30" type="text" id="TEACHER-NAME" /></td>
</tr>
<tr>
<td class="text1" align="right">Department</td>
<td><input name="DEPARTMENT" size="30" maxlength="30" type="text" id="DEPARTMENT" /></td>
</tr>
<tr>
<td class="text1" align="right">Subject Matter</td>
<td><input name="SUBJECT" size="30" maxlength="30" type="text" id="SUBJECT" /></td>
</tr>
<tr>
<td valign="top" class="text1" align="right">Describe how the nominee has had an impact on your academic/personal life.</td>
<td><textarea name="IMPACT" rows="10" cols="30" id="IMPACT"></textarea></td>
</tr>
<tr>
<td valign="top" class="text1" align="right">Provide examples of the nominee’s creative teaching practices and techniques.</td>
<td><textarea name="TEACHINGTECHNIQUES" rows="10" cols="30" id="TEACHINGTECHNIQUES"></textarea></td>
</tr>
<tr>
<td valign="top" class="text1" align="right">Describe your nominee’s interest and involvement in SIUE students including availability and advising, both inside and outside of the classroom.</td>
<td><textarea name="INVOLVEMENT" rows="10" cols="30" id="INVOLVEMENT"></textarea></td>
</tr>
<tr>
<td valign="top" class="text1" colspan="2" align="center"><input name="Submit" type="submit" value="Submit" /> <input name="reset" type="reset" value="Reset" /></td>
</tr>
</table>
</form>