Please use this form to verify you have completed all requirements to achieve the award of Distinguished Toastmaster (DTM).
You must be a paid member of the club listed below at the time Toastmasters International receives this form.
Please be sure you:
■ Complete all requirements before submitting this application to World Headquarters.
■ Ask one of your current club officers to email, fax OR mail (one method only please) the completed form to:
Email: educationprogram@toastmasters.org Mail: Education Services
Fax: +1 (303) 799-7753 Toastmasters International
9127 South Jamaica Street, Suite 400
Englewood, CO 80112, USA
PATH COMPLETION
Two paths in the Toastmasters Pathways learning experience have been completed:
in print
online or using accessible materials
Path 1 _____________________________ Date __________ Path 2 _________________________Date ___________
DISTINGUISHED TOASTMASTER PROJECT
Completed on this date: ___________________________________________________________________________
CLUB OFFICER ROLE COMPLETION
Served either one 12-month term (July 1 – June 30) or two six-month terms (either July 1 to December 31 or January
1 to June 30) as a club officer (president, vice president education, vice president membership, vice president public
relations, secretary, treasurer, or sergeant at arms) and participated in the preparation of a Club Success Plan and in a
district-sponsored club-officer training program while serving in this office.
Office held ____________________________________________ in Club No. ___________ Dates served ___________
Office held ____________________________________________ in Club No. ___________ Dates served ___________
Helped prepare a Club Success Plan for my club ______________________________ (must coincide with one of the
above officer terms)
Month Year
Attended officer training ____________________________ (must coincide with one of the above officer terms)
Month Year
MY INFORMATION (required for shipment of the DTM plaque)
________________________________________________________________
Name
________________________________________________________________
Address line 1
________________________________________________________________
Address line 2
________________________________________________________________________________________________________________
City State or province Country Postal Code
________________________________________________________________________________________________________________
Phone number Email address
_____________________________________
Member number
_____________________________________
Club name
_____________________________________
Completion date
DISTINGUISHED TOASTMASTER (DTM)
AWARD APPLICATION
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