FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. 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 May 1. If you have any questions, please contact Margaret Ford, the selection committee chair, at margeford@gmail.com, 83 Creed Circle, Campbell, OH 44405.

NOTE: You may copy long responses from WORD or another word-processing program and paste 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. Phone number at which we might reach you:

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* 6. Name of Faculty Advisor for the Affiliate:

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* 7. Email Address:

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

SECTION I

These activities are REQUIRED for qualification. Please check all that apply and be sure to paste in the requested support materials or send electronically by attaching at the end of the application. Deadline for submission of application: May 1.

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* 9. Our affiliate is recognized as an NCTE Student Affiliate. NOTE: To be recognized, your affiliate should be listed on the affiliate page on the NCTE website. If your group is not on the list but you feel it should be, please contact NCTE at affsec@ncte.org.

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* 10. Our affiliate has a minimum of 10 members.

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* 11. At least 10 members hold student memberships in NCTE.

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* 12. ALL members of the student affiliate are members of either NCTE or the local/state affiliate.

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* 13. Our affiliate has a set of Bylaws that provides for a smooth transition/succession of officers from year to year, including years when current officers graduate. Please paste your Bylaws into the box below or send electronically by attaching to the end of this application.

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* 14. Our student affiliate holds at least four formal meetings a year. Please paste in the box, with spaces between each, meeting agenda and minutes, including the date and time of the meeting or send electronically by attaching to the end of this application.

SECTION II

Each affiliate applying for the award must complete at least TWO of the FOUR (item numbers 15, 21, 24, and 25 plus any explanatory/evidence items and the required reflections that follow) activities listed below IN ADDITION TO THE REQUIRED activities in SECTION I. Please check all that apply and be sure to paste in or send the requested support materials electronically by attaching at the end of the application.

See a sample of the "Student Affiliate Award Evaluation Rubric" used by the selection committee members. It might help you in completing the information below.

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* 15. Maintains regular communications with current members through appropriate channels. Please check all that apply.

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* 16. Please submit any supporting documents electronically. (See end of application.)

  Sent once a year Sent twice a year Sent three or more times a year Will submit below
Webpage communication URL
Newsletter
Journal
Letter from president
Other

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* 17. If you are submitting website messages, please provide the URLs for them below. (NOTE: Social media posts like Facebook and Twitter are not considered website messages.)

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

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* 19. If you are citing a newsletter, please include the URL of the online issue or the name and issue of the newsletter in the boxes below.

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* 20. If you are citing a journal, please include the URL of the online issue or the name and issue of the journal in the boxes below.

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* 21. Participate in and engage in active reflection on at least one external professional learning program/event each year on a topic related to education or the ELA field.

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* 22. Please provide a one-paragraph description including documentation of the program/event.

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* 23. Please provide evidence of active reflection of the program/event such as minutes of meetings where the event was discussed, sample discussion forum posts regarding the event, etc.

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* 24. Participate in a project or activity directly involved with curriculum development, either through the affiliate or through local or state education agencies. Paste in below a brief description of the project.

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* 25. Develop a new or become involved in an existing local, state, regional, or national initiative related to literacy and English language arts, including being involved in evaluating the results of the initiative. Write a brief description of the affiliate's participation in the initiative and paste it in below.

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* 26. Please list all the supporting materials that you will be attaching electronically.

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* 27. Submit support documents.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 28. Submit support documents.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File

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* 29. Submit support documents.

DOCX, DOC, JPEG, GIF, JPG, PDF, PNG file types only.
Choose File
FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. Any support documents should be sent electronically by attaching above. The application and all supporting documents should be submitted no later than May 1. If you have any questions, please contact Margaret Ford, the selection committee chair, at margeford@gmail.com, 83 Creed Circle, Campbell, OH 44405.

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