FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. If possible, any supporting documents should be sent electronically by attaching them at the end of this application. The application and all supporting documents should be submitted no later than July 15. If you have any questions, please contact Kirstey Ewald, the selection committee chair, at kewald@centralriversaea.org, 1521 Technology Parkway, Cedar Falls, IA 50613.

NOTE: You may copy long responses from WORD or another word-processing program and past them into the survey form.

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* 1. Complete Name of Affiliate:

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* 2. Name of Person Submitting Application:

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* 3. Position in Affiliate:

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* 4. Email Address:

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* 5. Complete Mailing Address:

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* 6. If selected would your affiliate be responsible for having  a representative on hand to receive the award at the Affiliate Roundtable Breakfast on Sunday morning of the NCTE Annual Convention? (NOTE: The representative is expected to purchase a breakfast ticket with preregistration.)

SECTION I

These activites are REQUIRED for qualification. Please check all that apply and be sure to attach the requested materials. Deadline for submission of application: July 15.

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* 7. Please INDICATE if your affiliate has increased its membership through one of the following ways. NOTE: Membership counts are based on membership lists you have submitted to NCTE in the year of the award and the year previous to the award.

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* 8. If your affiliate conducted a unique membership campaign, please provide a one-page description of that campaign.

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* 9. What type of communications instrument does your affiliate publish at least twice a year? Please check all that apply as long as they are published two times each year or more.

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* 10. Please submit your supporting documents at the end of this application, if possible, or list what documents you will be mailing. Please complete no later than July 15.

  Will submit below Will send by US mail
First webpage communication URL
Second webpage communication URL
First newsletter
Second newsletter
First journal
Second journal
First letter from president
Second letter from president
First other
Second other

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* 11. If you are submitting website messages, please provide the URLs for them below.

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* 12. If you are submitting letters from your president, please paste these in below with five spaces in between each letter. Please label the letters as needed.

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* 13. If you are citing a newsletter, please include the URL of an online issue or the name and issue of the newsletter you'll be sending by US mail in the boxes below.

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* 14. If you are citing a journal, please include the URL of an online issue or the name and issue of the journal you'll be sending by US mail in the boxes below.

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* 15. Indicate which English language arts professional learning program (s) / event (s) your affiliate has provided for its members.

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* 16. Please provide a one-paragraph description of the program/event.

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* 17. Register for and attend at least TWO affiliate sponsored activities at the NCTE Annual Convention in November. Include a list of participants with each activity attended.

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* 18. Complete the NCTE Annual Affiliate Report Forms by the July 15 deadline for this award. See Annual Affiliate Report Checklist sent to affiliate presidents and liaison officers in April of the year of the award. All forms must be submitted along with a check for the dues and a current membership list, to be eligible for this award.

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* 19. In addition to the Affiliate Excellence Award, apply to at least ONE other NCTE affiliate awards program.

  Applied this year. Did not apply this year.
Affiliate Multicultural Program Award
NCTE Fund Teachers for the Dream Affiliate Award
Affiliate Newsletter Award
Affiliate Journal Award
Affiliate Website Award
NCTE Leadership Development Award
NCTE Intellectual Freedom Award (State, Regional, and Provincial)
NCTE High School Teacher of Excellence Award

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* 20. Participate with at least ONE delegate in NCTE's Affiliate Leadership Conference. Include names(s) of delegate(s) and date/place of conference below.

SECTION II

Each Affiliate applying for the award must complete at least FOUR of the activities listed below IN ADDITION TO THE REQUIRED activities in SECTION I. Please check all that apply and be sure to attach the requested support materials.

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* 21. Implement and maintain a plan for affiliate activities that incorporates cultural diversity and inclusion in the language arts profession.

Paste in a copy of your plan. If possible, include web links to any supporting materials OR indicate that you will send them by US mail. If possible, please attach copies at the end of this application.

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* 22. Publish a second communications instrument IN ADDITION TO the one communications instrument in REQUIRED activity #2 in Section I. If you listed more than one communications instrument in Section I, choose one of those for this question. Please include samples of this additional communications instrument.

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* 23. As an affiliate, nominate at least one member of the affiliate for an NCTE office or nominating committee.

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* 24. Participate in advocacy or policy making activities during the year. Include a brief description of the activity along with any supporting materials. Include if you'll be mailing supporting materials.

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* 25. Participate in a project or activity directly involved with curriculum development, either through the affiliate or through local or state education agencies. Include a brief description and include any supporting materials. Indicate if you will be mailing any support materials. You may attach materials below.

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* 26. Develop and carry out a program or activity that directly involves members of the local community in English language arts activities. Include a brief description and any supporting materials. Indicate if you will be mailing any supporting materials. You may attach materials below.

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* 27. Create an affiliate strategic plan for multiple years that includes an annual budget. Please paste in a copy of the plan and budget. If a strategic plan is already in place, please indicate that and paste in an updated annual budget and a report on progress on goals for the past year.

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* 28. Please list all the supporting materials that you will be attaching electronically or sending via US mail.

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* 29. Submit support documents.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
No file chosen

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* 30. Submit support documents.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
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No file chosen

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* 31. Submit support documents.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
No file chosen
FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. If possible, any supporting documents should be sent electronically by attaching them at the end of this application. The application and all supporting documents should be submitted no later than July 15. If you have any questions, please contact Kirstey Ewald, the selection committee chair, at kewald@centralriversaea.org, 1521 Technology Parkway, Cedar Falls, IA 50613.

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