National Technical Honor Society

Instructor Nomination Form

Please give the completed nomination form to the student who will submit with the application.

Name of Student Nominee: _________________________________________________

Academic Program: _______________________________________________________

Nominating Instructor_____________________________Class/Subject________________________

Is this student interested in pursuing a career in this field of study? Yes_____ No______

List any outstanding accomplishments of the nominee:_______________________________________________________________________________________________________________________________________________________________________________________________________________

List any outstanding academic or professional (career-related) qualities of the nominee_________________________________________________________________________________________________________________________________________________________________________________________________________________

Please check the appropriate answer:

Follows instructions Yes____No____
Safety conscious Yes____No____

Works well with others Yes____No____

Is dependable, trustworthy, responsible, honest Yes____No____

Takes pride in work Yes____No____

Exhibits good attitude Yes____No____

Exhibits leadership Yes____No____

Exhibits good citizenship Yes____No____

Additional comments related to the student’s qualifications for membership into the society__________________________________________________________________________________________________________________________________________________________________________________________________________________

I recommend this student as member of NTHS without any reservations Yes____No____

Instructor Signature and date:

__________________________________ Date ________________________