Alpha Theta State
Achievement Award

1. Criteria
   1. Primary consideration in selecting the nominee for the award should be given to the nominee's notable achievements at the chapter, state, regional, and international levels of Delta Kappa Gamma.
   2. In addition, achievement in one or a combination of the following areas may be considered:
      1. Excellence in teaching
      2. Contributions to the profession through activity in other professional organizations
      3. Contributions through activities outside nominee's professional area
      4. Research and publications
   3. Nominee must be present at the state convention to receive the award.
2. Implementation
   1. Responsibility for nominations belong to the chapter president, chairman of Personal Growth and Services, and the chapter chairman of the Professional Affairs Committee.
   2. Chapter finalists are to be selected by the Chapter Executive Board.
   3. The one chapter nominee from among the finalists is to be selected by the chapter membership.
   4. Have your chapter nominee complete the Member Information Sheet and send a copy to the state committee chair. Please include any other documentation your nominee feels is important.

March 15 is the deadline for the state chair to receive nominations.

Member Information Sheet

   Date:                                                

         Last                  First
   Name:                

  Phone:  -

         Street                     City             State  Zip
Address:       

            Chapter          
1. Chapter in which you are currently a member 
       Alpha
       Beta
       Gamma
       Zeta
       Theta
       Iota
       Kappa
       Lambda
       Mu
       Nu
       Xi
       Omicron
       Pi
       Rho
       Sigma
       Chi
       Psi
       Omega
       Alpha Alpha
       Alpha Beta
       Alpha Gamma
 Years: 
     Other Chapters in which you have been a member:
     Chapter  State  Years 
     Chapter  State  Years 

2. Initiation date Delta Kappa Gamma: 

3. Current Status 

4. Education:
   College/University                 Degree                           Date
        
        
        
   Additional Endorsements/Degrees    Degree/Endorsement               Date
        
        
         

5. Employment History:
   School                             Subject/grade/position           Years
        
        
         
        
                                                         

6. Positions held at Delta Kappa Gamma International Level, and years served:
   
   
   
   

7. Positions held at Delta Kappa Gamma State Level, and years served:
  Yrs      Yrs 
  Yrs      Yrs 
  Yrs      Yrs 
  Yrs      Yrs 
  Yrs      Yrs 

8. Positions held at Delta Kappa Gamma Chapter Level, and years served:
  Yrs      Yrs 
  Yrs      Yrs 
  Yrs      Yrs 
  Yrs      Yrs 
  Yrs      Yrs 

9. Recognition and participation outside Delta Kappa Gamma

    a. Recognition for Excellence in Teaching
       Recognition                                                             Years
         
         
         
         


    b. Recognition for Excellence in other than Teaching
       Recognition                                                             Years
         
         
         

    c. Other professional organizations to which you belong and are active
       Organization                        Positions held                      Years
          
          
          

10. Contributions through activities in other than professional organizations
           
           
           
           
           
           

11. Contributions through activities outside Professional Area
           
           
           
           
           
           

12. Research and Publications
           
           
           
           
           
             

Instructions for Submission
Fill in form, print it out on your computer, and send via US Mail to:

Nyla Adamson 
1901 Vintage Woods Court
Salt Lake City, UT 84117