BEA DAVIS LEADERSHIP SEMINAR APPLICATION June 7 9, 2019 DEADLINE: January 15, 2019

Transcription

1 BEA DAVIS LEADERSHIP SEMINAR APPLICATION June 7 9, 2019 DEADLINE: January 15, 2019 The purpose of the Bea Davis Leadership Seminar is to train potential leaders for service to Epsilon State and Delta Kappa Gamma. The seminar is held in early June of odd-numbered years, beginning on a Friday afternoon and continuing through breakfast on Sunday. Funding for this special Seminar was made available through a bequest from the estate of Miss Beatrice Davis, a past Louisiana State President and Southeast Regional Director. Requirements: A minimum of three full years in good standing with Epsilon State and evidence of: leadership potential as demonstrated by holding chapter office or involvement in committee work of Delta Kappa Gamma, professional involvement, attendance at an Epsilon State District Meeting or State Convention, state representation. The following persons are not eligible for participation: present or past elected state officers and former international Golden Gift Leadership/Management Seminar participants. Bea Davis Leadership Seminar application process has 3 parts: Application, Recommendation Forms, and Checklist with required signatures. (See information listed below and the attached forms.) A colored picture not greater than 4x6 is required; it may be ed as an attachment to Part 1 or may be mailed with Parts 2 and 3. Part 1 Application Form Application Form pages 1-3 must be ed to Martha Turner, State Leadership Development Chairman at marthajune.turner@gmail.com by January 15, Parts 2 and 3 must be sent by certified mail or scanned then ed to the following address no later than January 15, 2019: Certified mail: Martha Turner, State Development Chairman 2429 Clearbrook Way Haughton, LA marthajune.turner@gmail.com Part 2 Recommendation Forms Chapter President s Recommendation Professional Reference Recommendation Part 3 Checklist Chapter Treasurer s Signature Applicant s Signature DIRECTIONS: All responses MUST be typed. Answers must be confined to the space provided on this application form; therefore, be concise and precise in completing this form. Be selective in specification of contributions or awards. Name Last First MI _ Date Initiated Chapter Number of Members District Address Phone Street or PO Box City Zip LEADERSHIP POTENTIAL 1. Have you held any of the following offices at the CHAPTER LEVEL? (Check all that apply) President Recording Secretary First Vice President Parliamentarian Second Vice President Treasurer Corresponding Secretary Which CHAPTER LEVEL committee have you CHAIRED? (Check all that apply) Program Nominations Personal Growth and Services Rules Professional Affairs Communications Research Scholarships Music Representative World Fellowships Finance Other (Specify) Part 1: Application Form, Page 1

2 2. Have you served as DISTRICT DIRECTOR? How many DISTRICT MEETINGS have you attended? Have you ever CHAIRED a committee when your chapter hosted a DISTRICT MEETING? How many times have you participated on the program at a DISTRICT MEETING? 3. How many STATE CONVENTIONS have you attended? Have you participated on a STATE CONVENTION PROGRAM? Have you served on any STATE COMMITTEE? If YES, name the committee(s): Have you received a STATE SCHOLARSHIP? Have you served as the State President, State First Vice President, State Second Vice President, or State Recording Secretary? 4. Have you ever received an INTERNATIONAL GOLDEN GIFT AWARD to participate in the LEADERSHIP MANAGEMENT SEMINAR? How many REGIONAL CONFERENCES have you attended? Were you ever on a REGIONAL CONFERENCE PROGRAM? How many INTERNATIONAL CONVENTIONS have you attended? Were you ever on an INTERNATIONAL CONVENTION PROGRAM? Have you served on an INTERNATIONAL COMMITTEE? Have you received an INTERNATIONAL SCHOLARSHIP? In three words, name the CHARACTERISTICS that best describe you.,, PROFESSIONAL INVOLVEMENT Indicate facts about the highest earned degree which you hold: Degree: University/College: Areas of Certification: Year Earned: Current Position Employer/Location (If retired, list last.) Your MAJOR professional responsibility List the Membership and Offices held in MAJOR PROFESSIONAL ORGANIZATION(S) other than the SOCIETY. (Begin with most recent. Do not use acronyms or initials.) Dates Organization Involvement Part 1: Application Form, Page 2

3 COMMUNITY INVOLVEMENT List the Membership and Offices held in COMMUNITY ORGANIZATION(S) other than the SOCIETY. (Begin with most recent. Do not use acronyms or initials.) Dates Organization Involvement GENERAL In what ways would you be willing to share with other members of Epsilon State, your District, and your Chapter the skills acquired in the BEATRICE DAVIS LEADERSHIP SEMINAR? How will you use skills acquired in the BEATRICE DAVIS LEADERSHIP SEMINAR in your professional career? Why do you want to participate in the BEATRICE DAVIS LEADERSHIP SEMINAR? DEADLINE FOR APPLICATION All Parts of this application must be COMPLETED and ED no later than January 15, FOR OFFICE USE ONLY Date Received: Part 1: Application Form, Page 3

4 CHAPTER PRESIDENT RECOMMENDATION FORM 2019 BEATRICE DAVIS LEADERSHIP SEMINAR The Delta Kappa Gamma Society International Epsilon State Organization (Type or Print) Mrs. Mrs. (Applicant's Name) (Reference Name) Street or PO Box (Reference Address) City State Zip ( ) ( ) Business Phone Home Phone 1. How long have you known the applicant and in what capacity? 2. From your point of view, what are the applicant's principle strengths? 3. What has the applicant done to evidence leadership potential or professional competency to be endorsed for this award? (Specifics) Part 2: Recommendation Forms, Chapter President

5 4. Rate this applicant: Outstanding Superior Good Average Not able to determine (Explain) Chapter President Recommendation (Continued) 5. In addition to the information indicated above, any additional comments that you might share to assist the committee in the selection process would be appreciated. 6. CHAPTER PRESIDENT: (Or Immediate Past President if current President is applying.) (Print Name) (Signature) (Date) PLEASE RETURN COMPLETED FORM TO APPLICANT IN THE SELF-ADDRESSED STAMPED ENVELOPE NO LATER THAN THANK YOU FOR YOUR ASSISTANCE FOR OFFICE USE ONLY Postmark/ Date: Part 2: Recommendation Forms, Chapter President

6 PROFESSIONAL REFERENCE RECOMMENDATION 2019 BEATRICE LEADERSHIP SEMINAR The Delta Kappa Gamma Society International Epsilon State Organization (Type or Print) Mrs. Mrs. Street or PO Box (Applicant's Name) (Reference Name) (Reference Address) City State Zip ( ) ( ) Business Phone Home Phone 1. How long have you known the applicant and in what capacity? 2. From your point of view, what are the applicant's principle strengths? 3. What has the applicant done to evidence leadership potential or professional competency to be endorsed for this award? (Specifics) Part 2: Recommendation Forms, Professional Reference

7 4. Rate this applicant: Outstanding Superior Good Average Not able to determine (Explain) Professional Reference Recommendation (Continued) 5. In addition to the information indicated above, any additional comments that you might share to assist the committee in the selection process would be appreciated. 6, Professional Referent s Signature (Print Name) (Signature) (Date) PLEASE RETURN COMPLETED FORM TO APPLICANT IN THE SELF-ADDRESSED STAMPED ENVELOPE NO LATER THAN. THANK YOU FOR YOUR ASSISTANCE FOR OFFICE USE ONLY Postmark/ Date: Part 2: Recommendation Forms, Professional Reference

8 2019 BEATRICE DAVIS LEADERSHIP SEMINAR APPLICATION CHECKLIST (Submit with application) The FOLLOWING ITEMS ARE REQUIRED for application to be considered for the BEATRICE DAVIS LEADERSHIP SEMINAR: 1. Photograph (Send as attachment to Part 1: Application Forms, Pages 1-3 or mail a picture no larger than 4 x 6 with Parts 2 & 3) a. May be used for publicity purposes. b. Is not considered part of the applicant s papers which are used by the committee in selecting recipients. 2. Part 1: Application Forms, Pages 1-3 to marthajune.turner@gmail.com no later than January 15, Mail Parts 2 & 3 (items A-D below) by certified mail to Martha Turner, State Leadership Development Chairman, 2429 Clearbrook Way, Haughton, LA or scan Parts 2 & 3 (items A-D below) then marthajune.turner@gmail.com no later than January 15, A. Chapter President Recommendation B. Professional Reference Recommendation C. Verification of Dues Payment (Chapter Treasurer Signature) D. This Application Checklist Complete information below: RECOMMENDATIONS BY: A. Chapter President Recommendation (or Immediate Past President, if current president is the applicant) Mrs Street or PO Box City State Zip B. Professional Reference Recommendation Mrs Street or PO Box City State Zip C. Treasurer Certification of Required Membership Status and Payment of Current Dues Signature of Chapter Treasurer Date D. Applicant s Certification I certify that the information provided in this application is correct and I have met the specified requirements to apply. Signature of Applicant Date Part 3: Application Checklist