Student Affiliate Roster Statement

PLEASE SEND UPDATES AS THEY OCCUR THROUGHOUT THE YEAR!

BY SEPTEMBER 15, RETURN WITH CURRENT ROSTER TO: Division Director of Communications and Affiliate Services, NCTE, 1111 W. Kenyon Road, Urbana, Illinois 61801-1096; fax: 217-278-3760; e-mail: .

According to the rules of affiliation with NCTE described in the NCTE Constitution, Article V. Section C., the faculty sponsor and all members of the student affiliate governing board must be student members of NCTE, and the student affiliate must have at least 10 NCTE Student members.  To indicate that you've checked with your officers to make sure they are NCTE members, please sign and return this form with your other forms.

Full Name of Student Affiliate:

Academic Year of Statement:

___I have checked with all the persons listed as officers, editors, and members of the governing board and they affirm that they are members of NCTE.

NAME/SIGNATURE:
POSITION IN STUDENT AFFILIATE:                                     DATE:

For each individual please include as much of this information as possible. Please use format below as a sample.

Name:                                         Preferred mailing address: ___ home ___ work 
Institution Address:                      Work phone:
                                                  Home phone:
                                                  Fax:
Home address:                            E-mail address:
                                                  Date of election:
                                                  Term of office: