Literacy Ambassador Registration

1. 2010 Literacy Ambassador Registration

Literacy Ambassador Program Registration Form
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You must complete a separate form for each student nomination. There is no limit to the number of nominees. Registrations are due October 1, 2010.
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* 1. Student Nominated:

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* 2. This nominee is a:

Current student

Former student

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* 3. Length of time in program:

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* 4. Organizational Representative who will be attending:

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* 5. Organizational Representative Email:

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* 6. Do you plan on spending the night on Thursday, October 14? This is applicable for individuals traveling more than 200 miles.

Yes

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* 7. Do you plan on spending the night on Friday, October 15? This is applicable for indivudals traveling more than 50 miles.

Yes

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* 8. If muliple individuals are accepted, do you plan on traveling in the same vehicle?

Yes

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* 9. Has the nominee done any public speaking or interviews for your organization?

Yes

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* 10. Organization:

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* 11. Address:

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* 12. Phone:

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* 13. Fax:

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* 14. Why do you think this student would make a good Literacy Ambassador?