~ 2020 ~
Nomination must be postmarked or emailed to by March 1, 2020 to be considered.
I. Biographical Information
Name ________________________________________________________________
Address _______________________________________________________________
City _________________________________________ Zip ____________________
Email _________________________________ Phone Number _________________
Professional Experience: Please describe professional achievements within the past five years.
II. Membership Information
Induction Date ___________ Chapter ____________________ State ______
Current Chapter ________________________ NC DKG Region _________________
III. Chapter Contributions
Meeting attendance:
Total # chapter meetings ________
Number attended _____________
Revised 6/19/2019
DKG Offices Held (President, First VP, Second VP, Secretary, Treasurer)
DKG Committees Chaired
DKG Services/Contributions (Committees, positions, [ie. webmaster, social media contact,
editor], DKG workshops/programs that nominee has initiated, any activities in which nominee
participated to further the purposes of the Society)
IV. DKG Beyond the Chapter
NC DKG Regional (events attended, contributions, workshops presented include title and location).
Revised 6/19/2019
DKG State and International (conventions attended, publications and workshops presented
include title and location).
Community Service (contributions to school, community, church, and other organizations)
V. Recommendation
This is your opportunity to convince the committee why your nominee is a Rising Star.
250 words or less
Excerpts may be used during the recognition ceremony.
Revised 6/19/2019
VI. Nomination Submitted By
Chapter ___________________________ President __________________________
President’s email address ________________________________________________
President’s phone ______________________________________________________
Region _____________________________
Please email a photo of the nominee with this application. Do not embed a photo into
the application.
If you have questions regarding the application, please email Teresa Shadoin, Awards
Committee Chairman at
Chapter must ensure that arrangements are made for the nominee to be in attendance
at the awards ceremony. NC DKG is not responsible for recipient’s expenses.
Revised 6/19/2019
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