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2012-2013 Stipend Form for State/Provincial Coordinators and Directors of Membership Development

The International Reading Association Board of Directors has authorized a stipend for reimbursement for State and Provincial Coordinators and Directors of Membership Development.

Please be sure to complete all information below that pertains to your current role as a Council Officer (one section pertains to Coordinators contributions and the other to the DMDs contributions). PLEASE NOTE: A separate form must be completed for each Officer requesting a stipend. All Forms must be submitted by June 20, 2013.

Council Leader Information

* Council Name (no abbreviations)

* First Name

* Last Name

* Email Address

* Preferred Street Address

* City, State/Province and Postal Code

Coordinators Milestone(s)

Did you host a state/provincial leadership workshop for local councils during this year?

Yes

No

If Yes, how many councils were represented and what was the attendance?

List the active local and special interest councils in your state/province.

List any inactive councils.

How do you support your local councils?

	Check all that apply
Personal Site Visit
Email Communication
Zone/District/Regional Coordinators
Newsletter
Monetary Incentives

How can IRA further assist you in your position?

Director of Membership Development Milestone(s)

Did you host a membership booth/table at the state/provincial conference?

Yes

No

If you answered Yes, were the IRA resources displayed and promoted?

Yes

No

Please tell us how many new IRA members you have recruited this past year.

How do you support your local membership directors?

	Check all that apply
Leadership Workshop
Conference
IRA web-access membership database
Monitary Incentives

How can IRA further assist you in your position?

* Indicates Response Required

less than 5	5-10
11-20	21-30
31-40	41-50
51+