Heartspring Award for Innovation and Creativity in Special Education

Please complete the following form or print [PDF] and complete the application. Printed applications and/or supporting documentation (i.e. videos, photographs, portfolios, presentations, etc) can be mailed to:

Heartspring Award for Innovation and Creativity in Special Education
Attention: Heartspring Award
8700 East 29th Street North
Wichita, KS 67226

Applications must be received by April 20, 2009. If you have questions, please call 316.634.8881 or 800.835.1043 or email award@heartspring.org.

Applicant

*First Name:		*Last Name:
*Home Address:
*City:		State:	Zip:
*Country:	Please make a selection
*Home Phone:		Cell Phone:
*Email Address:	Please enter a valid email address

School/Organization

Name:
Address:
City:	State:	Zip:
Country:
Phone:	Fax:


*Name and location of commercial airport from which you would fly: A value is required.

*Tell us how you have made an innovative and outstanding contribution to special education. If you have any supporting documentation of your work (i.e. videos, photographs, portfolios, presentations, etc), please mail them to the address at the top of the page.

Questions/Comments:

As part of your application process, please complete the following sentence in a way that reflects your personality, your profession and your thoughts on the subject. “Being creative* and innovative in special education is like because .”

	If named as a Heartspring Award winner, I will attend the entire Heartspring Award for Innovation and Creativity in Special Education summer session, taking place from July 22 - July 25, 2009.

*Where did you learn about this award? Required.
Please describe, in detail, where you learned about the Heartspring Award:

Please type the two words you see below.