Curriculum Studies Award Copyright Verification Form

Curriculum Studies Network Award Copyright Verification Form
THIS FORM MUST BE COMPLETED AND SUBMITTED BY ALL CURRICULUM AUTHORS.

This form provides NAGC permission to reproduce and distribute this curriculum for purposes of the award review process.
Curriculum Title*
the sole author of this curriculumone of multiple authors of this curriculum
Please list the name, address, phone number, and email address of all curriculum authors.*
Authors Name (yours)*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Phone Number*
Please enter a valid phone number.Format: (000) 000-0000.
Email*
example@example.com
I agree
YesNo
By signing below, I verify that all the information contained in this nomination is true to the best of my knowledge.
Type Full Name Here*
Date*

MonthDayYear
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Curriculum Studies Network Award Copyright Verification Form