Nomination: Presidental & State Delegate Medallion

This online form will be sent directly to the State President upon submission. This form must be completed three (3) weeks prior to the state meeting. Upon completion of the form, click Submit; you will receive a confirmation screen if your report has been successfully submitted.
requiredIndicates a required field

Medallion Type: required Presidential
State Delegate
District Number: required   Area:  required
Nominee Information
Nominee's Name: required
Date Nominee Joined: required
Nominee's Address: required
Nominee's Theme (if applicable):  
Chapter: required   Size:  required
Include only offices, projects worked on, certifications completed and information relating to this year's activities. Be specific. Use facts, numbers and percentages to give a clear picture of nominee's accomplishments.
Local Meetings Held: required   # Attended:  required
District Meetings Held: required   # Attended:  required
State Meetings Held: required   # Attended:  required
National Meetings Held: required   # Attended:  required
Local Positions Held (current year): required
District Offices Held (current year): required
Certifications Completed (current year):
Othis/her Statewide Events Attended (current year): required
Number of new members signed by nominee:

List any new ideas implemented by nominee in his/her chaper or position: required
Explain how nominee fulfills his/her duties, what challenges she has overcome and why the nominee deserves the medallion: required
Nominator Information
Your Name: required
Your Position: required
Email Address: required
Phone: required
Chapter: required
Trimester: required 1 2 3
Click here to submit the form:
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