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The Delta Kappa Gamma Society International
Phi State (Kansas) Organization
National Board Certification Award

Note: This form may be completed online using the application form on the left or offline using the Microsoft Word document on the left. Once completed, the application may be submitted online or printed and sent by mail to:

Kim Oatney
Phi State Scholarship Committee Chair
415 W. Commercial
Waterville, KS 66548-9110

Guidelines

Eligibility

  1. The applicant shall have been a member of the Phi State Organization for two (2) years before making application for the NBC Award.
  2. The applicant must have met the eligibility for the forms and fee deadline of the National Board for Professional Teaching Standards.

Criteria for Selection

  1. Regular attendance at chapter meetings and participation in chapter activities are requirements for receiving the award.
  2. A State member would be exempt from the chapter qualification for two (2) years after her chapter dissolved.
  3. Applications shall be reviewed on a first-come, first-served basis.

Requirements

  1. Send a completed application to the Phi State Scholarship Committee Chair.
  2. Include a copy of the verification of registration number and reply letter.
  3. Application must be signed by applicant and chapter president or other chapter officer if applicant is the president.

Number and Payment of Awards

  1. Two (2) National Board Certification Awards of $1,000 each will be available during any one (1) calendar year.
  2. One-half (1/2) payment of $500 shall be made after having met the eligibility requirement and fees deadline. One-half (1/2) payment of $500 shall be made after the completion of the first year of study.
  3. The award(s) will be recognized during the Birthday Luncheon of the Phi State Convention.

Please address application materials to:

Kim Oatney
Phi State Scholarship Committee Chair
415 W. Commercial
Waterville, KS 66548-9110

National Board Certification Application (Microsoft Word document)

National Board Certification Award Application

Name
First:
Middle:
Last:
Street:
City:    State:    Zip Code:
Phone:
Email: (ALL CAPS)
Delta Kappa Gamma Chapter Information
Chapter:
Initiation Date:
State Members

State member give chapter name and date dissolved:
Chapter Name:
Date Dissolved:
Attendance
Number of chapter meetings attended last year?
Number of meetings applicant attended?
Offices / Services rendered to Delta Kappa Gamma
Office or Service Held:
Years:

Office or Service Held:
Years:

Office or Service Held:
Years:

Office or Service Held:
Years:

Office or Service Held:
Years:

Office or Service Held:
Years:

Chapter President
Name:
Signature:
Date:
Applicant Signature:
Name:
Signature:
Date:


Attach a copy of the verification of registration and reply letter. Verifications may be scanned and attached to the application form for electronic submission. Send or e-mail the completed application and verification to:

Kim Oatney
Phi State Scholarship Committee Chair
415 W. Commercial
Waterville, KS 66548-9110
Once completed, please send this form to:
Kim Oatney
Phi State Scholarship Committee Chair
415 W. Commercial
Waterville, KS 66548-9110
postmarked no later than February 1, 2010

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