1. Innovative Teachers Leadership Award ITLA Note : Please follow the Instructions as specified in the ITLA template guideline.doc file, available in the Teachers Competition folder to complete this template

2. Index 1. Section – A Section – A Applicants profile 2. Section - B 3. Section – C – Letters of Support a. Professional Reflections b. Teachers PPT c. Community Work a. Administrator/ Principal/ Regional Co- ordinator b. Parent or Community Member c. Colleague

3. Section A Personal Profile Registration Segment (Public / Private School, Government School, Special Category*) Name of the Teacher Date of Birth (MM/DD/YY) : Address for Communication House No.Street TownDistrict StatePIN code Email Id : (live or hotmail ) Personal Contact No. Landline with STD Code Mobile School Name and Address Languages familiar with Teaching Focus e.g. Maths, Science, Social Studies etc. Classes Taught I access my PC at: (Home/ School/ i-café/Do not access) Do you have a Passport? (Yes/No) If YES, Passport No. Expiry Date I would like to receive communication from Microsoft on such events and other activities: (Yes/No)

4. Section B a.Professional Reflections Double Click on the Icon below to write about your professional Reflections. Section-B

5. Teachers PPT. (Best Lesson plan) Name of the presentation submitted for the contest Class or age group (ppt. meant for which class or age group) Objective After inserting the object (refer guidelines) Resize and place your embedded Ppt. here (you will see the first slide of your lesson plan) Section-B

6. List of Teachers work (other than the one submitted as ITLA contest entry): S.NoName of the Lesson PlanTarget Class No. of Students Covered 1. 2. 3. 4. 5. 6. 7. 8. 9. 10. Section-B

7. Community Work – Screenshot 1 (scanned document) A brief synopsis of the screen shot ( in 1 or 2 lines): Section-B

8. Community Work – Screenshot 2 (scanned document) A brief synopsis of the screen shot ( in 1 or 2 lines): Section-B

9. A brief synopsis of the screen shot ( in 1 or 2 lines): Section-B Community Work – Screenshot 3 (scanned document)

10. List of other work done towards community (Do not repeat the scanned items): S.NoName of the Community Work Beneficiaries & remarks Section-B

11. Section C Letters of Support

12. Letter of Support (Scanned copy) Administrator/ Principal/ Regional Co- ordinator Section-C

13. Letter of Support (Scanned copy) : Parent or Community Member Section-C

14. Letter of Support (Scanned copy) : Colleague Section-C

15. Message from the Teacher:

16. Acknowledgement