Nomination and photograph of the nominee must be received together by 5 p.m. September 28, 2007. Electronic submission is required. E-mail the completed nomination to Carol Norden, 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.

DESCRIPTION: This award honors an ESP member who has made valuable contributions/expansions of an Extension program in another country through in-state or overseas work.

INFORMATION ABOUT THE NOMINEE

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 contributions to international programs.)

III. Program Accomplishments (Of greatest importance to this nomination are the contributions to a recognized international program and might include references to teaching/training foreign students in the U.S. about Extension; providing technical assistance in a cooperating/host country; implementing new ideas and/or research or assisting with programs in host country; and showing competence in program leadership in education.)

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

Date

Xi Chapter ESP