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Name__________________________________________________________________
Mailing
Address_________________________________________________________
City________________________________
State ___________ Zip________________
Work Phone
__________________________Home Phone _______________________
Fax__________________ Email
____________________________________________
Nominated by
State__________________________________________________________
Regional
Officer/Designee_________________________________________________
Institution______________________________________________________________
Address_______________________________________________________________
Work
Phone_____________________________ Home or Cell____________________
Email__________________________________________________________________
Application Checklist
In addition to this cover
page, please be sure that all components are included:
o
A letter of
nomination from nominating body (schools, professional org., etc.)
o
A letter of
support from state organization
o
A current resume
or c.v. of no more than two pages
o
A signed
Commitment Form expressing the nominee’s willingness to complete their proposed
project and present findings at their state conference and NECTFL Conference
the calendar year following acceptance of their project.
o
A written
narrative by the nominee describing their project, containing the following:
o
Project
Rationale: How will this project contribute to the field and advance quality
language instruction? Why should NECTFL
support this project?
o
Project
Description: What is your project? What goals and objectives do you hope to
accomplish?
o
Action Plan: What steps will you take to implement the
project? What is your timeline? Please keep in mind that you need to present at
the following year’s state and NECTFL conferences.
o
Leadership
Statement: How will your project provide leadership at the local, state,
regional, and national level?
NECTFL MEAD Leadership Fellows
Commitment Form
If selected as a Mead Fellow, I, ____________________________ will commit to complete my proposed project and present the findings at my state conference and the NECTFL Conference the calendar year following acceptance of the project.
_____________________________________________
Applicant Signature
_________________________________________
Date
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