NCTE Affiliate Intellectual Freedom Award Application 2017

Established in 1997, this award is given by affiliates to individuals, groups, or institutions that merit recognition for advancing the cause of intellectual freedom. Deadline for application is May 1.

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* 1. Complete name of affiliate giving the award:

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* 2. Please give contact information for the nominator (contact person) for the award.

Name of Nominator and Contact Person for the Award:

Position in Affiliate:

Street Address:

City:

State/Province:

Zip Code:

Email Address:

Phone Number:

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* 3. Please give contact information of award recipient.

Name:

Institutional Affiliation:

Preferred Address (indicate H or O):

City:

State/Province:

Zip Code:

Email Address:

Phone Number (indicate O, H, or C):

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* 4. Does the recipient give her/his permission to receive this award?

Yes

No

Other (please specify)

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* 5. Explain in fewer than 100 words why the nominee merits this recognition (this explanation will be used in descriptions of award winner for the Affiliate Breakfast program and press release):

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* 6. Paste in concise documentation and/or testimony of not less than 250 words or more than 750 words explaining why the nominee merits this award.

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* 7. Please provide the name and city of the newspaper to be contacted about the award winner.

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* 8. Will the award winner be able to attend the NCTE Annual Convention to be recognized at the Sunday morning Affiliate Breakfast? Should your awardee be unable to attend the Convention, please contact NCTE so we can plan to recognize the winner at the Breakfast and send the certificate by mail.

Yes

No

Other (please specify)

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 may be mailing in support of this submission. SEND THE DOCUMENTS by May 1 to Affiliate Office, NCTE, 1111 W. Kenyon Rd., Urbana, IL 61801; affsec@ncte.org or Linda Walters-Moore, lwaltersmoore@ncte.org.