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 your journal is a print journal, mail a copy of this completed form along with FOUR copies of ONE issue of your affiliate's journal published between May 1 of the previous year and May of the year of the award to Kirstey Ewald, Central Rivers Area Education Agency, 1521 Technology Parkway, Cedar Falls IA 50677. If you have questions, please contact her at kewald@centralriversaea.org.

NOTE: You may copy long responses from WORD or another word-processing program and paste them into the survey form.

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* 1. Please provide the following information about your affiliate's journal.

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* 2. Our affiliate's journal is

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* 3. If you answered "online only" above, please provide the URL of AND access to your journal online.

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* 4. Please describe the purpose of your affiliate's journal.

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* 5. Please list the strengths of your affiliate's journal.

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* 6. What is the approximate cost per issue of your journal?

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

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* 9. 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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* 10. Submit support documents.

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

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* 11. Submit support documents.

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

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* 12. 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 your journal is a print journal, mail a copy of this completed form along with FOUR copies of ONE issue of your affiliate's journal published between May 1 of the previous year and May of the year of the award to Kirstey Ewald, Central Rivers Area Education Agency, 1521 Technology Parkway, Cedar Falls IA 50677. If you have questions, please contact her at kewald@centralriversaea.org.

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