Edyth May Sliffe Award

Information Response Form
To:   Principal or Headmaster
From:   RuthAnn Royer, MAA AMC Sliffe Coordinator
Date:
March 2006

Three (or more) of your students who compose the team for the 2006 American Mathematics Contest 12 (AMC 12) have nominated a teacher for the Edyth May Sliffe Award for Distinguished High School Mathematics Teaching. Please submit this information by April 15, 2006.

In order to process the Edyth May Sliffe Award, I would appreciate it if you would provide the information requested below, in case your nominee receives one of the awards.

I will also need a photo of the teacher (head and shoulders, any size), for the AMC Web Site, and the AMC 10/12/AIME High School Summary. This photo can be scanned and attached to an email, -- sent to "rroyer1@unl.edu", or mailed to:

RuthAnn Royer,
American Math Competitions,
University of Nebraska- Lincoln,
1740 Vine Street,
Lincoln, NE 68588-0658.

Thank you for taking the time to fill in this information. In doing so, you help us honor this teacher.

Teacher Information
Teacher Nominated:
Last Title First Middle
School CEEB:
School:
School Type: Public
Private
Home School
School Address:
City: State
Zip: --
School Website:  
Teacher's School Phone: / - ext.
Home Phone: / -
School Email:
Home Email:  
Social Security Number:
(needed for the check)		  
Please enter without dashes or spaces This form will email the contents to me, without encrypting them. If you feel uncomfortable submitting the Social Security Number this way, you may call to leave the Number with me. My direct line is 402/472-6561, and our toll free number is 800/527-3690. I am usually available to take phone calls from 8-3:30 Central time, Monday thru Friday.
US
Canadian
Home Address:
City: State
Zip:   --

School Information
Principal or Headmaster:
Title First Middle Last
Position: Principal
Head Master
Other
Principal or Headmaster's Email:  
School Phone:   / - ext.
Superintendent:  
Title First Middle Last
 
President of School Board or District:  
Title First Middle Last
Is the above named person employed as a mathematics teacher at your school for the school year 2005-2006?
If not, please explain the postition/relationship of the person nominated.
Are all three (or more) AMC 12 team members enrolled at your school for 2005-2006?
If not, please explain:

I will be submitting the photo