Nomination and photograph of the nominee must be received together by 5 p.m. September 28, 2007. Electronic submission is required. E-mail completed nomination to Stan Dixon, Chairman of Awards and Recognition Committee, at stan_dixon@ncsu.edu. (Exception: Nominations and print photographs submitted by retirees may be sent by mail but must reach chair by stated deadline. Mail to:Stan Dixon, Greene County Cooperative Extension Center, 229 Kingold Blvd., Snow Hill, NC 28580.)

Nominations more than 1 (one) page (back and front) will NOT be reviewed. Award nominations will only be accepted in straight text, Microsoft Word or StarOffice writer format. No HTML or PDF formats will be accepted. Margins must be 1-inch and information presented must be of 10-point type.

Be sure that all information is included.

Mark (x) the appropriate award.

_____ State Distinguished Service Award (20+ years of Extension service)
_____ State Continued Service Award (for continued contributions 5 or more years after winning state DSA)
_____ State Mid-Career Service Award (10-20 years of Extension service)
_____ State Early-Career Service Award (up to 10 years of Extension service)
_____ State Meritorious Support Award (support staff)
_____ State Administrative Leadership Award (administrator with 10+ years of Extension service)

Full Name
Title
Current Address
Phone
E-mail Address
Educational background (Include schools, colleges, universities, dates attended, degrees.)

I. Career History (Reverse chronological listing of employment, titles, and dates; especially employment record with Extension.)

II. Professional Accomplishments (Achievements and honors that particularly relate to Extension. Include innovative programs, workshops, special projects. etc., that have significantly influenced attitudes or motivated favorable actions with clientele.)

III. Program Accomplishments (Clearly explain the career highlights that show the professional and leadership role the candidate has played in planning, implementing and/or administering strong Extension policies, procedures, programs and trends at the state, regional and national levels.)

IV. Epsilon Sigma Phi Involvement (summary of involvement)

V. Summary Statement of Support (Concise, well-written, easy-to-read narrative summary statement of 50-75 words)

INFORMATION ABOUT THE NOMINATOR
Name
County or Department

Date

Xi Chapter ESP