Superintendents

December 16, 2002

Page Two

 

 

 

Please complete the enclosed

State Instructional Materials Committee Member Nomination Form (Part 1)

for

each person you wish to nominate. Share the enclosed document entitled

Information for Prospective Members of

State Instructional Materials Committees

with the nominee and ask him/her to complete

State Instructional

Materials Committee Member Nomination Form (Part II)

and return it to you.

 

PLEASE RETURN THE NOMINATION FORM (PARTS I & II) BY JANUARY 15

TH

TO:

Pam Lastowski

Office of Instructional Materials

Florida Department of Education

325 West Gaines Street, Suite 532

Tallahassee, Florida 32399-0400

 

Your continuous support and assistance in the evaluation and selection of instructional materials is appreciated

and vital to the success of the program.

 

CC:JH:ecpl

 

Enclosures

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2003-2004

State Instructional Materials Committee Member

Nomination Form

 

DIRECTIONS FOR COMPLETING FORM: Please provide the following information regarding the

nominee. PART I of this form should be completed by the nominating individual, agency, or association.

PART II is to be completed by the nominee. Both PARTS I and II are to be mailed, TOGETHER,

  

by the

nominator, to the Office of Instructional Materials and Media Services, Florida Department of Education,

325 West Gaines, Suite 532, Tallahassee, FL. 32399-0400.

(Please print)

 

School District: __________________________________________________________________________

 

Name of Nominee: ________________________________________________________________________

 

Address of Nominee: ______________________________________________________________________

 

  

  

  

  

  

  

  

  

________________________________________________________________________________________

 

(City) (State) (Zip)

 

Telephone # of Nominee: _______

____________________________

(Home) (Business)

 

Email Address of Nominee: ________________________________________________________________

 

STATE INSTRUCTIONAL MATERIALS COMMITTEE FOR WHICH NOMINATION IS BEING SUBMITTED:

❏

K-

5

Computer Education

❏

Computer Ed/Business

❏

Marketing/Diversified Ed 9-12

❏

Tech/Tech Ed

❏

Mathematics K-5

❏

Mathematics 6-8

❏

Mathematics 9-12

Please check the category for which this nomination is being submitted.

_____ Teacher

  

Lay Citizen

_____ Supervisor of Teachers

  

School Board Member

 

Has this person been designated “Teacher of the Year” at any level? Yes____ No_____

If yes, please provide the information requested below.

 

 

School Level Name of School

  

 

 

  

  

  

  

  

Year of Award (Number, Street)

(City) (State) (Zip)

 

 

District Level Name of District

  

 

 

  

  

  

  

  

Year of Award (Number, Street)

(City) (State) (Zip)

 

 

Regional Level Name of Region

       

  

Year of Award

 

 

State Level Name of State

       

  

Year of Award

 

 

---

 

 

  

 

National Level

  

  

  

  

Year of Award

Name Of Agency, Association, Institution, Organization Or Individual Making The Nomination:

 

___________________________________________________________________________________________

(Individual)

(Title)

(Association/Institution/Organization)

 

Address: ____________________________________________________________________________________

(Number,

Street)

(City) (State) (Zip)

 

 

(____)____________________

 

(Telephone Number)

 

EMail: _____________________________________________________________________________________

 

 

 

 

 

 

  

Nomination forms, including both Parts I and II, are to be received by the Department of Education N0

LATER THAN 5 P.M. on Wednesday, JANUARY 15, 2003.

No faxes, please

.

Mail to:

 

Pam Lastowski

  

Office of Instructional Materials

Florida Department of Education

325

 

West Gaines Street, Suite 532

Tallahassee, Florida 32399-0400

---

 

PART II

 

2003-2004

State Instructional Materials Committee Member

Nomination Form

 

DIRECTIONS: This portion of the nomination form is to be completed by the nominee and returned

to the individual person, agency or association doing the nominating. Do not mail PART II without

PART I.

(Please Print)

 

Name: __________________________________________________________________________

 

Address: __________________________________________________________________________

 

  

__________________________________________________________________________

(City)

(County)

(State)

(Zip)

 

Telephone:

__________________________

  

(Home)

(Business)

 

E-Mail Address: _______________________________________________________________________

 

Are you a resident of the state of Florida?

Yes

No________

 

Occupation: _________________________________________________________________________

 

Job Title:

_________________________________________________________________________

 

Name and Address of Present Employer:

_____________________________________________________________________________________

 

_____________________________________________________________________________________

 

_____________________________________________________________________________________

 

Have you ever been convicted of a felony or first degree misdemeanor? Yes _____ No _____

 

If yes, what charge(s)? _________________________________________________________________

 

Where?

When?

______________

 

Do you now hold or have you ever held a teaching certificate in the state of Florida or any other state?

Yes _____ No _____

 

Currently valid? Yes _____ No _____

Has your certificate ever been suspended or revoked in this or any other state? Yes _____ No _____

 

If yes, when?

___ Where? _____________________________

 

  

---

 

If you are presently a classroom teacher, please list below the subjects you are teaching and the grade

level(s) at which the instruction is provided.

 

 

SUBJECT AREA(S)

  

GRADE LEVEL(S)

 

 

  

 

 

  

 

 

  

 

If you are a supervisor, please list below the subject area(s) and grade level(s) for which you are

responsible:

 

 

SUBJECT AREA(S)

  

GRADE LEVEL(S)

 

  

 

 

  

 

 

  

 

Educational Background:

_____________________________________________________________________________________

 

 

  

 

Educational Experience:

(a) Teaching

  

 

 

  

 

 

  

 

(b) Administrative:

  

 

 

  

 

(c) Other (Include # of years and where employed):

  

 

 

  

 

Public Service (List any public office you now hold or have held or employment by a government agency

or service on federal, state and/or local advisory committees, commissions, councils or task forces.):

_____________________________________________________________________________________

Affiliations (List national, state, community and/or educational organizations in which you are now or

have been a member.):

  

 

 

  

  

  

  

  

  

  

  

  

  

  

  

  

 

 

  

 

 

  

---

 

Have you previously served on a state instructional materials committee? _____ Yes _____ No

Have you previously served on a district instructional materials committee? _____ Yes _____ No

When?

Subject?

_____________________________

 

 

REMARKS (Optional)

  

 

 

  

 

 

  

 

 

I hereby certify that all statements made in this questionnaire are to the best of my knowledge true and

correct.

 

_________________________________________ _________________________________________

 

(Nominee Signature)

(Supervisor Signature)

 

_________________________________________ _________________________________________

(Date)

(Date)

 

 

 

 

 

The information requested below is needed to satisfy Equal Employment Opportunity reporting

and research requirements.

 

❏❏❏

  

❏❏

  

❏❏❏❏

 

    

❏

    

❏

 

Social Security Number

Female

Male

 

 

  

Check the race/ethnic group with which you identify

   

❏

 

  

❏

 

   

❏

 

❏

 

❏

 

  

White

Black

Hispanic

Asian or

American Indian or

 

  

  

  

Pacific Islander Alaskan Native

 

 

 

Nominee: Please return completed Part II of the questionnaire to the person who is nominating

you.

Nominator: Please return the complete questionnaire, Parts I and II to:

 

Florida Department of Education

325 W. Gaines Street, Suite 532

Tallahassee, Florida 32399-0400

 

 

 

 

  

---

 

Florida Department of Education

Division of Public Schools and Community

Education

Bureau of Curriculum Instruction and

Assessment

Instructional Materials and Library Media

Services

 

 

 

 

 

 

 

  

INFORMATION FOR PROSPECTIVE MEMBERS

STATE INSTRUCTIONAL MATERIALS COMMITTEES

2003-2004 ADOPTION

 

You are being invited to become a nominee for appointment to a 2003-2004 state instructional materials

adoption committee. From the nominated individuals, the Florida Commissioner of Education will select

10 who have the qualifications to review and recommend in a specific subject area and represent the

demographic and cultural diversity of the state. Please review the information which follows; consider

the tasks and time involved and then, if you would like to be considered for an appointment, complete

 

Part II, State Instructional Materials Committee

and return it to the person who wishes to nominate you.

 

Composition of Committees and Term of Appointment

 

Each state instructional materials committee is composed of persons actively engaged in teaching or

supervision of teaching in the public schools of the state, lay citizens not professionally connected with

education, and a school board member. A majority shall be classroom teachers and, at minimum, two

supervisors of teachers, two lay citizens, and one school board member. The term of appointment is for

eighteen months.

 

Requirements for Membership

 

 

Affidavit: Each member must sign an affidavit to the effect that he/she will faithfully discharge the duties

imposed as a committee member and that he/she has no interest in any way with any publishing company.

A copy of the affidavit is attached for information only. A common question in regard to the affidavit is:

“I did some work last summer as a reviewer for a publishing company. Does that disqualify me from

serving on the committee?” The answer is “yes.” Any person who has done any work for pay for any

publishing company within the past five years is ineligible to serve. If you have any questions or

concerns about signing the affidavit, you may call the Florida Department of Education, Office of

Instructional Materials, (850) 487-8791 (Suncom 277-8791).

Certification: Classroom teachers must be certified in the area directly related to the academic area and

level being considered for adoption.

Training: All persons serving on instructional materials committees must complete the Department of

Education training program prior to beginning the review and selection of instructional materials.

 

Duties and Responsibilities of State Committees

 

 

Please consider the following in making your decision to serve on this committee. The responsibilities

include:

 

 

(1)

To meet at the call of the Commissioner of Education.

 

(2)

To organize and elect a chairperson, a vice-chairperson, and a recorder.

 

(3)

To evaluate instructional materials according to adopted criteria and legal requirements.

(4)

 

To recommend instructional materials for adoption.

(5)

 

To report the findings of the Committee to the Commissioner of Education

 

 

  

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2003-2004 Schedule

 

Summer 2003:

All committee members must plan to attend a two-day joint training and organization

meeting, traditionally, in June. The meeting begins at 8:30 a.m. on the first day and ends no later than

2:00 p.m. on the second day.

 

No later than

 

July 15, committee members will receive evaluation samples of the instructional materials

submitted by publishers. Each member is expected to evaluate the materials following established

procedures and suggestions provided in the training program.

 

Fall 2003:

In the fall of 2003, each committee will meet, individually, to finalize its evaluations and to

recommend materials for state adoption.

 

Expenses for Attending Meetings

 

Committee members will be reimbursed for travel and hotel expenses and $21.00 per day, on a prorated

basis, for meals. Travel and expense forms will be completed at each meeting for reimbursement of

expenses paid out of pocket by members. A check will be issued and mailed to the members in two to

four weeks following the meeting.

 

Substitute teacher cost will be reimbursed to district school boards for all workdays that a teacher is

absent attending meetings of the state committee. After each meeting, a reimbursement claim form will

be prepared for each teacher member and sent to the district superintendent’s office for completion.

 

The task of evaluating instructional materials for state adoption requires a good deal of time and

effort.

However, it is a task that is very important and worthwhile. Persons who serve on state

instructional materials committees contribute significantly to the success of education in Florida schools.

 

If this is an area in which you would like to serve, please complete

Part II

 

2003-2004 State

Instructional

 

Materials Committee Member Nomination Form

and return it to the person who wishes

to nominate you to the Commissioner of Education for consideration for appointment.

 

If you have questions concerning committee membership, please feel free to call Pam Lastowski, Florida

Department of Education, Office of Instructional Materials. The telephone number is (800) 307-6928.