2008 Alan Shepard Technology in Education Award
Entry Form

1. Category of Entry: (please circle one)

 K-12 School Level             K-12 District Level

2. Applicant Information: (please circle one)

             Dr.            Mr.             Ms.             Mrs.             Miss

Candidate Name: _______________________________________________________

Job Title:  _____________________________________________________________

E-mail: _______________________________________________________________

School or District Name:  _________________________________________________

School or District Address: ________________________________________________

_____________________________________________________________________

Web Address:  _________________________________________________________

Phone: ___________________________ Fax: ________________________________

Name of Principal: ______________________________________________________

Name of Superintendent: _________________________________________________ 


3. Contact: (person nominating the candidate).

Name: ________________________________________________________________

Address: ______________________________________________________________

Phone: ____________________________ Fax:________________________________

E-mail: _______________________________________________________________


4. ____________________________________________________________________

Signature                                                                                          Date    

 

 

 

 

 

2008 Alan Shepard Technology in Education Award
Demographic Profile

 

 

  1. Total number of students in school or district: _________________
  2. Type of school(s):
    __ Elementary
    __ Middle (6-8)
    __ Junior High  (6-9)
    __ Senior High
    __ Other (please specify)__________________________________
     
  3.  Population Category:
    __ Urban
    __ Suburban
    __ Rural
  4. Total number of students impacted by the individual: ___________
  5. Special characteristics of your school or district which you believe are relevant to your application:
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________
    ___________________________________________________________________

 

2008 Alan Shepard Technology in Education Award
Checklist


This page is provided to assist you in compiling your application.

  1. Have you completed and included each of the following?
        •  Entry form
        •  Demographic profile   
        •  Abstract (one single-sided, double-spaced page)
        •  Description of technology development programs (not more than 3 single-sided, double spaced  page)
         •     Published curriculum material, software, photographs, etc. may also be included.

  2. Please provide an original and three photocopies of the submission, but only one set of support material.  
  3. Only mailed applications received no later than January 17, 2008 will be accepted.
     
  4. Mail to: 

Via regular mail:

                       The Astronauts Memorial Foundation
                        The Alan Shepard Award
                        Mail Code AMF 
                        Kennedy Space Center, FL 32899

Physical address for Federal Express or UPS:

                        The Astronauts Memorial Foundation
                        The Alan Shepard Award
                        State Road 405
                        Building M6-306, Room 5000
                        Kennedy Space Center, FL 3899

 

 

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