The Delta Kappa Gamma Society International
Alpha Iota State
Scholarship Application Form

The scholarship committee decides the named scholarship awarded based on
educational study.
Bylaws stated below.
Two (2) $1,000 scholarships may be awarded annually for degree study.
One shall be named the Effie M. Downer scholarship.
One shall be named the Ola B. Hiller scholarship.
One $800 Past Presidents' Scholarship may be awarded annually for graduate study.
Two (2) $500 scholarships may be awarded annually for re-training and/or
additional endorsement in education

INSTRUCTIONS: Please print or type all information.  Attachments may be used when appropriate.  Send the completed application form with a set of credentials to the State Scholarship Chairman as shown on the last page.

I	Personal Data

Name:	
Complete Address:	
	
Phone:	

II	The Delta Kappa Gamma Society International Membership

Membership of 	Chapter, Alpha Iota State
Chapter Location:	
Date of Initiation:	
Indicate specific office, committee chairmanships, committee memberships, and participation. Indicate year of each.
Chapter Level:	

	
	
State Level:	

International Level:	

	
II	The Delta Kappa Gamma Society International Membership (continued)

Describe specific participation, service and responsibilities for Delta Kappa Gamma conventions, workshops, and seminars.  Indicate year of each.
Workshops:	

	
	
State Conventions:	

	
Regional Conventions:	

International Conventions and Seminars:	

III	College/University Education

List in chronological order all post high school education you have received.
Name of Institution	Dates	Degree	Major/Area
	Attended  	Date Received	of Specialization

	
	
*Send proof of current college or university enrollment with your application.
IV	
Experience

List in chronological order all educational positions you have held, including teaching, supervisory and administrative positions
Name of Institution	Position Title	Dates Held

	
	
List any other professional or business positions you have held.
Position	Location	Dates Held

	
Additional Experiences:
Please include your travel, exchange programs, seminars, conferences attended, etc.

	
V	Recognition for Achievement

Publications (attach copy of title page or first page of article):	

Creative productions (performance, TV, radio, exhibits, lectures, seminar or workshop presentations, etc.):	

Scholarships, Fellowships, Grants:	

	
Special Honors:	

VI	
Additional Organizations

Please indicate positions held.
Professional:	

Civic and Community:	

	
Other:	

VII	Proposed Use of Scholarship

Institution:	
Your proposed plan of study during the scholarship year and degree to be obtained:	

	

	
Benefit you expect to derive from this proposed plan of study:	

	

VIII	
References

Please include your Chapter President, Administrator, and a Community Representative from an organization which has benefited from your participation or interest. Each reference should include a letter of recommendation to the chairman of the State Scholarships Committee.  (It is your responsibility to see that all letters of recommendation arrive by the February 1st deadline.)

1.	Chapter President:
Name:	
Complete Address:	

2.	Administrator:
Name:	
Complete Address:	

3.	Representative from a Community Organization with whom you have served:
Name:	Organization Represented:	
Complete Address:	

Please attach any additional references to this application.

   Deadline: March 15   .  

Applicant’s Signature:	

Applicant’s Printed Name:	

Date of Application:	

Return to:  	Gloria Fisher
	1207 Fitch Street
	Albion, MI 49224
	Dkg.gloria@gmail.com
	517-629-7670