Print/Media/Broadcast Award

NOMINATION FORM

I nominate ____________________________________________ for the Media/Print/Broadcast Award. I have a working relationship with the nominee and verify all of the supporting documents that are attached. In my opinion, the nominee has demonstrated leadership in media, print, and/or broadcast activities in the following ways:

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Nominator _____________________________ Phone ________________________

Address _____________________________ City _________________ Zip ______

Length of time I have worked with the nominee: _______________________________

Capacity ____________________________________________________________

Supporting Documents: These are to be selected by the nominee. The documentation may be in the form of photos, samples of materials, project description, brochures, and so on. Total documentation may not exceed five 8 1/2" X 11" pages.

Deadline for Submissions: This nomination form, together with supporting documents, must be received by the Publicity and Publications Chairperson by March 1. Send to:

The award will be presented at the annual conference of the Florida Reading Association.

Name of Nominee ________________________________ Phone ______________

Address ______________________________ City _______________ Zip _______