NOMINATION FORM FOR CANDIDATES

TO THE NECTFL BOARD OF DIRECTORS

I recommend the following persons. Each lives in our region (ME, NH, VT, MA, RI, CT, NY, NJ, PA, DE, MD, DC, VA, WV), has attended the Conference at least once, and is a leader with the ability and willingness to work as a Director for four years and to serve as Conference Chair.

NAME:______________________________________________________________________________

INSTITUTIONAL AFFILIATION:_______________________________________________________

HOME ADDRESS:____________________________________________________________________

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PHONES: (HOME)_____________________________(WORK)_______________________________

(FAX):___________________________(E-MAIL)____________________________________

POSITION (include level/grade taught):_________________________________________________

LANGUAGE(S):______________________________________________________________________

EVIDENCE OF PROFESSIONAL ACTIVITY/CONTRIBUTIONS: _____________________________________________________________________________________

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NAME:______________________________________________________________________________

INSTITUTIONAL AFFILIATION:_______________________________________________________

HOME ADDRESS:____________________________________________________________________

_____________________________________________________________________________________

PHONES: (HOME)_____________________________(WORK)_______________________________

(FAX):___________________________(E-MAIL)_____________________________________

POSITION (include level/grade taught):_________________________________________________

LANGUAGE(S):______________________________________________________________________

EVIDENCE OF PROFESSIONAL ACTIVITY/CONTRIBUTIONS:

_____________________________________________________________________________________

_____________________________________________________________________________________