Jack and Jilly Gold Star Classroom Award
Teacher’s name _____________________________________________
School _____________________________________________________
School system _______________________________________________
Teacher’s email address ______________________________________
Teacher’s school phone number ________________________
Documentation: Send a 1-3 page paper attached to this form telling why you think your classroom should be the Jack and Jilly Gold Star Classroom. You should include documentation to support your paper. Documentation might include pictures, student artwork, and new games to use with Dr. Cupp Readers®.
Winners will be featured in the January Online Newsletter.
Applications will be judged by three retired educators. The applicant with the highest score will receive a $300 check in December. Second place winner will receive a $200 award and third place winner will receive a $100 award.
Applications will be judged as follows:
If you include pictures of any students, you must have on file written parent permission for the student(s) to have their pictures used on our web page. By signing this application, you confirm that parent letters are on file in your school.
Applications and all documentation must be postmarked no later than November 15, 2004. Mail to: Cindy Cupp, 5 Log Landing Road, Savannah, Georgia 31411.
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Teacher’s signature Principal’s signature