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Exemplary Reading Program Award Application Form

This is not an electronic form!

Please fill out and print this proposal form, complete the information needed, and mail it with your program description to:

Exemplary Reading Program Award
International Reading Association
800 Barksdale Road
PO Box 8139
Newark, DE 19714-8139, USA

DEADLINE:
Applications must be postmarked by November 15 and arrive at IRA Headquarters by November 22. Faxed applications will not be accepted.
Year:
1. Location of the Exemplary Reading Program:
School Name
Principal's Name
Street Address
City, State/Province, Postal Code
Telephone (include Area Code)
Principal's Signature (This must be included in order for application to be complete.)
   
2. School District
Name of District
   
3. Name and Signature of Chief School Officer, e g., Superintendent:
Name
Street Address
City State/Province/Postal Code
Telephone (include Area Code)
Signature (This must be included in order for application to be complete.)
   
4. IRA Member in the School
Name
IRA Membership #
Exp. Date
(Current IRA membership # must be incuded in order for application to be complete.)
   
5. Contact Person (the individual to be contacted regarding this application)
Name
Position
   
6. Demographic Information:
a. The school is: Public  Private
b. Grade level(s) of students in the Exemplary Reading Program
c. Approximate ethnic background of students in the school (%) Asian American
African American
Caucasian
Hispanic
Native American
Other
Other (please describe)
d. Which of the following terms apply to the school: Urban inner-city
Urban (above 250,000 general population)
Urban (10,000-250,000 general population)
Small town (up to 10,000 general population)
Suburban (adjacent to urban center)
Rural
e. Socioeconomic status (check one): Low
Low Md.
Md.
Md. High
High
f. Approximate per-pupil expenditure in the district: $
In the school:
$
g. Approximate allocated time for reading/language arts per week
h. Approximate class size
i. Instructional grouping pattern(s)
   
7. Name and Address of News Media Contact:
Name
Street Address
City, State/Province, Postal Code
Additional News Media Contact
Name
Street Address
City, State/Province, Postal Code
   
8. As part of the description, please attach a sheet listing the names and professional assignments of all those who were involved in completing the application.
   
 

 

 
This page last updated October 31 2007

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