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. If you have questions, please contact Jeana Hrepich, the selection committee chair, at jhrepich@gmail.com, 2816 Harvard Avenue E, Seattle, WA 98102.

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. Please provide the following information about your affiliate's website.

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* 2. Please describe the purpose of your affiliate's website.

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* 3. Please list the strengths of your affiliate's website.

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* 4. 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.)

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

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

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* 7. Submit support documents.

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

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* 8. Submit support documents.

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

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* 9. 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. If possible, any supporting documents should be sent electronically by attaching above. If you have questions, please contact Jeana Hrepich, the selection committee chair, at jhrepich@gmail.com, 2816 Harvard Avenue E, Seattle, WA 98102..

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