NCTE Affiliate Leadership Development Award Submission Form 2016

NOTE: Currently there is NO funding for this award; however, affiliates may wish to continue this recognition at the local level and support award winners with travel funds to the NCTE Annual Convention where they will be recognized and presented with a certificate at the Affiliate Breakfast on Sunday morning (those who attend the breakfast will need to purchase a ticket with their conference registration). 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.

Please note that only NEW leaders (1-5 years experience) from state, provincial, and regional affiliates are eligible for this award and that only one awardee is allowed. Both parts of this form must arrive by May 1 to NCTE, to affsec@ncte.org or to Linda Walters-Moore, lwaltersmoore@ncte.org.

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* 1. Complete name of affiliate:

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* 2. Name and email of affiliate president:

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

Name of Nominator and Contact Person for the Award: *

Street Address: *

Address 2:

City: *

State: *

Zip Code: *

Email Address: *

Phone Number: *

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* 4. Please give information about the recipient of the award.

Name of Award Winner:

School:

City, State, Zip

Preferred Address (indicate H or O):

City:

State:

Zip Code:

Email Address

Phone Number

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* 5. How many years has award winner been teaching?

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* 6. Has the award winner ever attended the NCTE Annual Convention?

Yes

Other (please specify)

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* 7. What are the name and city of the local newspaper to receive information about the winner of the award?

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* 8. Please list the name(s), title(s), and email address(es) of others the winner would like to know about the award:

Person 1

Person 2

Person 3

A stipulation of the award is that the recipient agrees to participate in the affiliate during the academic year of the award and that the specifics of that participation are stated at the time of the award.

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* 9. Does the NCTE Leadership Development Award winner, agree to attend, if possible, the Affiliate Roundtable Breakfast at the NCTE Annual Convention in the year of the award to be recognized as a new affiliate leader?

Yes

Other (please specify)

Question Title

* 1. Complete name of affiliate:

Question Title

* 2. Name and email of affiliate president:

Question Title

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

Question Title

* 4. Please give information about the recipient of the award.

Question Title

* 5. How many years has award winner been teaching?

Question Title

* 6. Has the award winner ever attended the NCTE Annual Convention?

Question Title

* 7. What are the name and city of the local newspaper to receive information about the winner of the award?

Question Title

* 8. Please list the name(s), title(s), and email address(es) of others the winner would like to know about the award:

Question Title

* 9. Does the NCTE Leadership Development Award winner, agree to attend, if possible, the Affiliate Roundtable Breakfast at the NCTE Annual Convention in the year of the award to be recognized as a new affiliate leader?

Question Title

* 10. Please describe how the recipient of the award will participate in the affiliate during the academic year of the award.