NCTE/SLATE INTELLECTUAL FREEDOM AWARD SUMMARY SHEET

NATIONAL AWARD

Nominee's Name:

Institutional Affiliation:

Address:

Telephone:

Permission:

Explanation of why nominee merits consideration for this recognition (maximum 100 words):

I authorize that I am an NCTE member, that permission of nominee to be nominated has been obtained, and that eligibility and procedural criteria for nominations for this award have been met. Further documentation is attached.

Name:

Signature

Address:

Home Phone: (    ) 

Work Phone: (    )

Date:

E-mail:

Name and complete address of newspaper to be contacted:

If selected the nominee will ____ will not ____ be able to attend the NCTE Annual Convention to receive award.

Send this form with further documentation no later than May 1 to Millie Davis, Division Director of Communications & Affiliate Services, 1111 W. Kenyon Road, Urbana, IL 61801-1096; Phone: 800-369-6283, ext. 3634; Fax: 217-278-3760; E-mail: .