Application must be submitted with a photograph of the applicant and received by September 28, 2007, 5 p.m. 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.)

Applications more than 1 (one) page (back and front) will NOT be reviewed. Applications 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.

Listed below is the information to be included in the application. Be sure that all information is included. Nominations that exceed 1 page (front and back) will not be considered.

Remember nominations are not complete and will not be considered without the submission of a photograph of the individual.

Information About the Applicant
Name
Title
Address
E-mail address
Phone

Inclusive dates of Epsilon Sigma Phi membership: ___________ to ____________

Previous education

Colleges attended (dates and degrees)
Other professional training

Employment history (Reverse chronological order, beginning with current position; include dates held, employer and position)

Information About the Proposed Professional Improvement Program
Title of Program
Location
Beginning date of proposed educational program (include year)
Ending date or proposed educational program (include year)
Proposed degree to be completed (if applicable)

Professional Improvement Plan Description (the plan may be for graduate course(s), study toward a degree, or other project which will contribute toward professional improvement)

Xi Chapter ESP