NYSASCD
Journal - Impact on Instructional Improvement Article Submission
Print out a copy of this form and mail it to:
Dr. Anthony Mello, NYSASCD
Executive Director
15 Dogwood Lane
Tuxedo Park, NY 10987
Last Name:________________________________________
First Name: _______________________________________
Address:__________________________________________
City/State:_________________________ Zip:___________
E-mail Address:___________________________________
Phone (w): _______________Phone (h):______________
Fax:___________________________
School District or Organization:_____________________
Position:_________________________________________
I intend to submit an article
for the [enter month/year] __________issue of IMPACT.
The proposed title of my submission will be:_________
__________________________________________________
Briefly describe how this submission will address the theme of this
particular issue:
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
__________________________________________________
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