NCTE National Intellectual Freedom Award Application 2016 Established in 1997, this award is given to individuals, groups, or institutions that merit recognition for advancing the cause of intellectual freedom. Deadline for application is May 1. Question Title * 1. Is this a nomination by an individual or a group? Individual Group Please name the nominating group. Question Title * 2. Please give contact information for the nominator (contact person) for the award. Name of Nominator and Contact Person for the Award: Position in Nominating Group: Street Address: City: State -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Zip Code: Email Address Phone Number Question Title * 3. If this is an individual nomination, are you, the nominator, a member of NCTE? Yes No Other (please specify) Question Title * 4. Please give contact information of the award recipient. Name: Institutional Affiliation: Preferred Address (indicate H or O): City: State: -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming Zip Code: Email Address: Phone Number (indicate O, H, or C): Question Title * 5. Does the recipient give her/his permission to receive this award? Yes No Other (please specify) Question Title * 6. Explain in fewer than 100 words why the nominee merits this recognition (this explanation will be used in descriptions of award winner for the press release): Question Title * 7. 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. Question Title * 8. Please provide the name and city of the newspaper to be contacted about the award winner. Question Title * 9. Will the award winner be able to attend the NCTE Annual Convention to be recognized at the NCTE Awards Presentation on Saturday? 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. Done