Self-Nomination Form
2012
DEADLINE: SEPTEMBER 15, 2011
Name:
Professional Role (please select one): Teacher University Professor Librarian
If you are a teacher, please indicate grade level(s) taught:
If you are a librarian, please indicate if you are public or school:
ALAN Member? Yes No If yes, please indicate number of years: _________
Institutional Affiliation:
E-mail Address:
Mailing Address:
Phone Number(s):
Statement describing why you wish to serve on the committee (please include previous experience on juried committees, experiences as a book reviewer, etc.):
Names and contact information for two references able to speak to your potential to work in this capacity:
Reference Name E-mail Address and Phone Number
1)
2)
Please send this application electronically to:
Ricki Ginsberg, Chair
2011-12 Walden Committee
rickiginsberg@gmail.com