NCTE/SLATE NATIONAL Intellectual Freedom Award Application 2015

Established in 1997, this award is given to individuals, groups, or institutions that merit recognition for advancing the cause of intellectual freedom. Deadline for applications 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: *

Zip Code: *

Email Address: *

Phone Number: *

Question Title

* 3. If this is an individual nomination, are you, the nominator, a member of NCTE?

Yes

Other (please specify)

Question Title

* 4. Please give contact information of award recipient.

Name: *

Institutional Affiliation: *

Preferred Address (indicate H or O): *

Address 2:

City/Town: *

State: *

ZIP: *

Email Address:

Phone Number (indicate O, H, or C):

Question Title

* 5. Does the recipient give her/his permission to receive this award?

Yes

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 Thursday evening Opening General Session? If your nominee is unable to attend convention, NCTE will recognize the winner at the General Session and send the plaque or certificate by mail.

Yes

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.