Kansas Phi State Orgainization

Present a Nominee for the Phi State Achievement Award

Once completed, this form may be submitted online or printed and sent POSTMARKED NO LATER THAN FEBRUARY 1, 2011, to the Achievement Award Committee Chairman:

Rose Hieger
1362 Parkwood
Salina, KS 67401
Name of nominee:
Chapter of nominee:
Address of nominee:
Years of active membership in Delta Kappa Gamma:
Summary of the Achievements of the Nominee
Services to Chapter
Offices:
Committees:
Other outstanding contributions to chapter:

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Services to the State
Offices:
Committees:
Other outstanding contributions to Phi State:

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Services to the International Society
Contributions to the International Society:

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Attendance
Does the nominee usually attend district, state, regional, and international meetings? Yes     No
List some of the workshops, programs, or other responsibilities the nominee has had at these meetings:

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Name of MEMBER OF THE PHI STATE EXECUTIVE BOARD submitting the recommendation:
Executive Member’s Board Position:
Executive Member’s Chapter:
Date:


Once completed, please send this form to the
Achievement Award Committee Chairman:
Rose Hieger
1362 Parkwood
Salina, KS 67401
postmarked no later than February 1, 2009

       

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