AFFILIATE MULTICULTURAL PROGRAM AWARD
SUBMISSION FORM

Affiliate's Name (spell out complete name, please):

Contact Person:

Institutional Affiliation:
Address:                                                                                                                                                                    

Home Phone:

Fax Number:

Work Phone:

E-mail Address:

Brief description of program for publication in Affiliate Breakfast program booklet, Council-Grams, and January awards mailing to affiliates (also attach 1-2 page report and appropriate supporting documents):

If selected, would your affiliate be responsible for having a representative on hand for the awards presentation at the Affiliate Breakfast during the NCTE Annual Convention? (Representative is expected to purchase a breakfast ticket with conference preregistration). YES___  NO___

If YES, please provide name and contact information for representative:

Name:

Mailing Address:

Work phone:

Home phone:

E-mail address:

Name and complete address of newspaper to be contacted:

This form, 1-2 page report, and appropriate supporting documents must be postmarked and mailed to the participating SCOA Representative (Shirley Wright, 8412 Santa Ana Dr., Fort Worth, TX  76131-5315) no later than May 1 in the year of the award.