NCTE Affiliate Website Award Submission Form 2017 FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON.NOTE: You may copy long responses from WORD or another word-processing program and past them into the survey form. Question Title * 1. Please provide the following information about your affiliate's website. Affiliate's Name: Website URL: Affiliate Contact Person: Email Address: Website Editor's Full Name: Website Editor's Institutional Affiliation: Email Address: Website Co-Editor's Full Name: Website Co-Editor's Institutional Affiliation: Email Address: Question Title * 2. Please describe the purpose of your affiliate's website. Question Title * 3. Please list the strengths of your affiliate's website. Question Title * 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.) Yes No Other (please specify) Question Title * 5. If you answered, "yes," please provide the name and contact information for the representative. Name: Email Address: Question Title * 6. 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 FOR YOUR RECORDS, PLEASE PRINT ONE COPY OF THIS COMPLETED FORM BEFORE PRESSING THE "DONE" BUTTON. Done