2015 Education Service Center Region 12 School Counselor of the Year Nomination Application Nominee: First/Last Name________________________________________________ Nominee’s work e-mail :_________________________________ and/or home email: _____________________________ Home Address______________________________________________________________________ __________________________________________________________________________________ City State Zip Code Telephone School Name_______________________________________ District _________________________ School Address______________________________________________________________________ __________________________________________________________________________________ City State Zip Code Telephone Grade Level(s) currently served_________ Total Years of Experience as a Counselor ___________ Years in Present Position__________ Person nominating (if not a self-nomination): ___________________ I hereby give my permission that any or all of the attached materials or photos that may be taken of me can be shared with persons interested in promoting, in a variety of media, the ESC Region 12 School Counselor of the Year Award. Signature of Nominee_________________________________________________________ Principal: First/Last Name_________________________________________________________________ Principal’s e-mail address:_________________________________ Phone # (____ )________________ Signature of Principal____________________________________________________________________ District Superintendent: First/Last Name_____________________________________________________ Superintendent’s e-mail address _______________________________Phone # (____ ) ______________ Signature of Superintendent__________________________________________________________ The person responsible for nominating a school counselor for the ESC Region 12 Counselor of the Year is welcome to express their support for the nominee by attaching a brief letter of recommendation to this application. The deadline for the full application to be received at ESC Region 12 is 5 p.m., May 20, 2015. ESC USE ONLY Please answer the following questions under each specific heading, or attach pages as needed. II. Educational History and Professional Development (Limit: Two double-spaced pages) A. Beginning with the most recent, list colleges and universities and post-graduate studies, with degrees earned and dates attended. __________________________________________________________________________ B. Beginning with the most recent, list counseling employment history, with time periods, and grade levels __________________________________________________________________________ C. Beginning with the most recent, list professional association memberships, offices held and other relevant activities. __________________________________________________________________________ D. Beginning with the most recent, list staff development leadership activity and leadership activity in the training of future counselors. __________________________________________________________________________ E. Beginning with the most recent, list awards and/or other recognition. __________________________________________________________________________ III. Professional Biography (Limit: One page) What are the background, people and events that persuaded you to become a professional school counselor ? Describe your most significant contributions and accomplishments in education. V. Philosophy of Counseling (Limit: One page) Describe your personal feelings and beliefs about counseling, including your own ideas of what makes you an outstanding counselor. Describe the rewards you find in counseling. How are your beliefs about counseling demonstrated in your personal counseling style? VII. The Counseling Profession (Limit: One page) What do you do to strengthen and improve the counseling profession? What is or should be the basis for accountability in the counseling profession? 3-15/C 2