1. 2010 Literacy Ambassador Registration

Literacy Ambassador Program Registration Form
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You must complete a separate form for each student nomination. There is no limit to the number of nominees. Registrations are due October 1, 2010.
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1. Student Nominated:

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2. This nominee is a:

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3. Length of time in program:

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4. Organizational Representative who will be attending:

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5. Organizational Representative Email:

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6. Do you plan on spending the night on Thursday, October 14? This is applicable for individuals traveling more than 200 miles.

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7. Do you plan on spending the night on Friday, October 15? This is applicable for indivudals traveling more than 50 miles.

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8. If muliple individuals are accepted, do you plan on traveling in the same vehicle?

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9. Has the nominee done any public speaking or interviews for your organization?

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10. Organization:

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11. Address:

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12. Phone:

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13. Fax:

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14. Why do you think this student would make a good Literacy Ambassador?

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