2019 NCTE Affiliate Multicultural Program Award Submission Form

FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. If possible, any supporting materials 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 Lawrence Baines, the selection committee chair, at lbaines@ou.edu, 2720 Fairfield Drive, Norman, OK 73072-9636.

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. Please provide the following information about your affiliate.

Affiliate's Name:

Website URL:

Full Name of Affiliate Contact Person:

Affiliate Contact Person's Role in Affiliate:

Affiliate Contact Person's Institutional Affiliation:

Affiliate Contact Person's Email Address:

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* 2. Please provide a 1-2 page summary (250-500 words) describing your affiliate's multicultural programming.

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* 3. Please provide a brief description of your affiliate's multicultural program entry (50 words or fewer) to be printed in the Affiliate Breakfast Program if your affiliate wins the award.

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* 4. Please list any documents you'll be including to support your submission. THEN SEND THE DOCUMENTS by scanning and attaching them to the end of this application.

Supporting Document 1

Supporting Document 2

Supporting Document 3

Supporting Document 4

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* 5. If recognized, would your affiliate be responsible for having a representative on hand for the awards presentation at the Affiliate Breakfast during the NCTE Annual Convention? (NOTE: The representative is expected to purchase a breakfast ticket with preregistration.)

Yes

Other (please specify)

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* 6. If you answered, "yes," please provide the name and contact information for the representative.

Name:

Email Address:

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* 7. We'd like to contact the media in your area. Please let us know which newspaper(s) should receive a press release.

Name of Newspaper:

URL of Newspaper's Website

Name of Newspaper:

URL of Newspaper's Website

Name of Newspaper:

URL of Newspaper's Website

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* 8. Submit support documents.

Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported. File size limit is 16MB.

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

Choose File

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* 9. Submit support documents.

Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported. File size limit is 16MB.

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

Choose File

Question Title

* 10. Submit support documents.

Only PDF, DOC, DOCX, PNG, JPG, JPEG, GIF files are supported. File size limit is 16MB.

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. If possible, any supporting materials 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 Lawrence Baines, the selection committee chair, at lbaines@ou.edu, 2720 Fairfield Drive, Norman, OK 73072-9636.