FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. Please include a copy of the form with any documents you'll be mailing in support of this submission. SEND THE DOCUMENTS by May 1 to Margaret Ford, 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 Affiiate:

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* 2. Name of Person Submitting Application:

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* 3. Position in Affiliate:

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* 4. Institutional Affiliation:

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* 5. Email Address:

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* 6. Mailing Address:

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* 7. Phone number at which we might reach you:

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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 indicate that you will send them by postal mail. 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: http://www.ncte.org/affiliates/lists. If your group is not in the list but you feel it should be, please contact NCTE at affsec@ncte.org.

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* 10. Has a minimum of 10 members. Please list members with their addresses, phones, emails in the box or indicate that you will send a list by postal mail.

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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. 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 indicate that you will send it by postal mail.

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* 14. The student affiliate holds at least four formal meeting/year. Please paste in the box with spaces between each meeting agenda and minutes, including the date and time of the meeting, development of projects, members in attendance, guest speakers, etc. OR indicate that you will send by postal mail.

SECTION II

Each affiliate applying for the award must complete at least TWO of the activities listed below IN ADDITION TO THE REQUIRED activities in SECTION I. Please check all that apply and be sure to paste in or indicate that you will send via postal mail the requested support materials.

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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 your supporting documents online if possible and/or list any supporting documents you'll be mailing. SEND THE DOCUMENTS by US mail no later than May 1.

  Sent once a year Sent twice a year Sent three or more times a year Will submit below Will send by US mail
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,

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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 UR of the 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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* 20. If you are citing a journal, please include the URL of the 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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* 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 OR indicate that you will be sending this by postal mail.

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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. OR indicate that you will be sending this by postal mail.

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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. Paste in any supporting materials OR indicate if you will be mailing them.

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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. Paste in any supporting materials below OR indicate that you will be sending support materials by postal mail.

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* 26. Please list all the supporting materials that you will be sending via US mail.

FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. Please include a copy of the form with any documents you'll be mailing in support of this submission. SEND THE DOCUMENTS by May 1 to Margaret Ford, 83 Creed Circle, Campbell, OH 44405.

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