Your Information Name *
Phone * Alt Phone Email * Address
* Class Description Student Name *
Title of Class * Technique(s) Taught * Date *
MM slash DD slash YYYY
Class Length * Location * Class taught in conjunction with named event or show Class Cost * Additional cost Instructions / Handouts *
Was a class syllabus or instructions/handouts given for this class?
Certificate of Completion *
Was a certificate of completion issued to each student at the end of the class?
Teacher’s Comments on the Scholarship Student Student on time and prepared *
Was the student on time and prepared to take the class including all required materials?
Positive learning attitude *
Did the student have a positive learning attitude?
Student respectful *
Was the student respectful of the teacher and other students in class?
Class time sufficient *
Was the class time sufficient to learn the technique being taught and to finish the class project?
Student able to keep pace *
Was the student able to keep pace with the information being taught?
Classroom / Facilities Class size sufficient *
Was the class size allotted sufficient for the technique taught and the number of students?
Feel confident using this facility again *
Would you feel confident using this facility again to teach similar classes?
If you have any additional comments or information, please feel free to attach additional sheets or to contact the Awards Chairman at Awards@ices.com with additional information.
Additional Comments Additional Comment Upload Accepted file types: pdf, Max. file size: 256 MB. I Affirm *
I hereby affirm that all information given on this form is true and accurate.
This form is not complete unless you click “submit" and will be used as your digital signature.
Once you have submitted the form you should receive a “Thank You” confirmation email. If you do not receive this “Thank You” email then your form DID NOT go through and you will need to RE-SUBMIT your form. Please double check to make sure you: Have filled in all the required information, (a RED message will appear if information is missing).
Este formulario no está completo a menos que haga clic en "enviar".
Una vez que haya enviado el formulario, debe recibir un correo electrónico de confirmación de "Gracias". Si no recibe este correo electrónico de "Agradecimiento", entonces su formulario NO se envió y tendrá que REITERAR su formulario. Por favor, vuelva a verificar para asegurarse de que: Ha completado toda la información requerida (aparecerá un mensaje ROJO si falta información). Comments
This field is for validation purposes and should be left unchanged.