Golden Jubilee Professional Enrichment Fund

I.  Application Due Date:
                                                                         
     	April 29, 2011                                                                                                           
       


II. Personal Data
 
         Last                  First
   Name:  

  Phone:  -
         Street                     City             State  Zip
Address:       


III. The Delta Kappa Gamma Society International
 
Applicant must have been a member at least three years

           Chapter          City
Member of:  

           Year  City                                 State
Initiated:   

Indicate attendance and participation in chapter meetings; specific offices held;
committee chairmanships and memberships; attendance at international conventions.
List year(s) of involvement.

Chapter Level:
           
           
           
           
            
           
 
State Level:
           
           
           
           
           

International Level:
           
           
           
           
           

IV. Proposed Use of Stipend
Explain the proposed use of this stipend, including the following:
           
Title and brief description of project or study:
           
           
           
           

Relationship of project/study to purposes of Society:
           
           
           

Place and dates of project/study:
           
           

V. Comments and additional information (attach separate sheet)
 

VIII. Additional Information
List any other facts or special conditions you would like to have considered:
          
          
          



Chapter President Signature _____________________________________  Date ____________       
 
 
Applicant Signature _____________________________________  Date ____________

Instructions for Submission
Fill in form, print it out on your computer, get chapter president's signature, 
sign and send via US Mail to:

Sarah Voigt, Scholarships Chairman
401 E 500 N
Kaysville, UT 84037