Northeastern Region Individual Excellence in Extension Award Nomination

Northeastern Region Individual Excellence in Extension Award Nomination
Nominee Information
Full Name*

First NameLast Name
Email*
example@example.com
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.
Is this nomination being submitted by someone other than the nominee?*

YesNo
Nominator's full name*

First NameLast Name
Nominator's email address*
example@example.com
Nominator's phone number*
Please enter a valid phone number.
Third party email address
If you are completing this form for the person named above as nominator, please provide your email address.
Specify wording for an award citation - 15 words or less, suitable for engraving on a plaque (examples: "Exemplary Transfer of Knowledge to Diverse Audiences to Manage Farm Stress" or “Innovative Engagement with Underserved Audiences to Increase Consumer Economic Awareness and Stability”)*

0/15

Background Information
In the space below please provide background information, including education, professional development, and experience that specifically relates to nominee's Extension appointment. Reviewers will not use CVs except to break a tie score.
Suggested to be 375 words or less

Evaluation Criteria

In this next section, please provide narratives with data and anecdotes to support each criterion. The weight given is in parentheses. Responses should be limited to 500 words for each criterion.
Evaluation Criteria 1: Demonstrated high impact of programs, described by the following (500 total words or less). Weight – 50%*
The formal process by which needs that impact the public good were identified (10%)*

0/500
How the educational program was established to meet these needs (20%)*

0/500
Assessment of the program, specifically how the public good indicated by economic, social and/or environmental impact was evaluated (15%)*

0/500
How innovation was used (5%)*

0/500

Evaluation Criteria 2
Recognized excellence in one’s field of expertise as demonstrated by sustained funding and creative partnerships; professional recognition, request for speaking engagements beyond one’s geographic assignment; and development of educational resources, outputs and assessments (500 words or less). Weight – 10%*

Evaluation Criteria 3
Demonstrated impact regarding engaged scholarship principles, partnerships, funding, and educational program delivery (500 words or less). Weight – 20%*

Evaluation Criteria 4
Ability to engage university colleagues in Extension programming with evidence of teamwork both within and outside of Extension (500 words or less). Weight – 10%**

0/500

Evaluation Criteria 5
Demonstrated conveyance of cultural sensitivity and appreciation for diversity (500 words or less). Weight – 10%**

0/500

Submission
Signed letter of endorsement by the institution’s Extension Director or Administrator or his or her designee.*

Cancelof
NOTE: When you submit a nomination, you are agreeing to the following.
1. The nominee has five consecutive years of responsibility for Extension programming as of May 1, 2023.
2. The nominee has or will submit a statement for the impacts database (landgrantimpacts.org) which portrays the Cooperative Extension the work, all or in part, related to this nomination.
3. The information in this nomination is factual.
After submission, you will receive an email confirmation within approximately 30 minutes. If you do not receive a message, please contact Bill Hoffman at whoffman@aplu.org.
Check box to agree.*

I agree
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Nominee Information