NCTE LEADERSHIP DEVELOPMENT AWARD

Supported by Pearson Prentice Hall Education

 NATIONAL SUBMISSION FORM FOR AFFILIATE AWARDEES AND ALTERNATES

Please note that only new leaders from state, provincial, and regional affiliates are eligible for this award and that only one awardee and one alternate per affiliate are allowed.  Please click here for criteria and considerations in selection awardee.

Both parts of this form must arrive by May 1 to NCTE Division Director of Communications & Affiliate Services, 1111 W. Kenyon TE., Urbana, IL 61801; fax; 217-278-3761

Please print the following information.

Name of Affiliate:                               

Name of nominator:

Home phone;

Office phone:

Fax:

E-mail address:

Name of New Leader AWARDEE:

Mailing Address:

Home Phone:

E-mail Address:

Fax:

Name of School:

Office Phone:

Address:

Years of Teaching Experience:

 
For AWARDEE:
Name of Local Newspaper to Receive Information About Your Award:

E-mail Address:

Names(s), Title(s), and Address(es) of others you would like to know about your award:

I __________________________________(the above listed new leader) agree to attend the Affiliate Roundtable Breakfast at the NCTE Annual Convention in the year of the award to both be recognized as a new affiliate leader and to sign the new leader roster (a breakfast ticket will be provided).  I affirm that I have not previously attended an NCTE Annual Convention.  In addition, I agree to participate in my affiliate during the academic year of the award in the following ways (please list those ways below):  

Signature of AWARDEE: ________________________________________
Date: _____________________

It is important to choose an alternate:  first to involve two new people and, second, because it’s quite possible that something will come up to prevent your awardee from attending convention and without an alternate your affiliate will have no representative.

Name of New Leader ALTERNATE:

Mailing Address:

Home Phone:

E-mail Address:

Fax:

Name of School:

Office Phone:

Address:

Years of Teaching Experience:

For ALTERNATE:
Name of Local Newspaper to Receive Information About Your Award:

Address:

Names(s), Title(s), and Address(es) of others you would like to know about your award:

I __________________________________(the above listed new leader) agree to attend the Affiliate Roundtable Breakfast at the NCTE Annual Convention in the year of the award to both be recognized as a new affiliate leader and to sign the new leader roster (a breakfast ticket will be provided).  I affirm that I have not previously attended an NCTE Annual Convention.  In addition, I agree to participate in my affiliate during the academic year of the award in the following ways (please list those ways below):  

Signature of ALTERNATE: ________________________________________
Date: _____________________