The Penne Ferrell Fund Literacy Award Application Due November 1
The Delta Kappa Gamma Society International ~ California ~ Support Team for Emerging Professionals
Email address *
Please read the prompts for each question very carefully. The asterisk indicates that a response to the question is required. Please note the "red box" which might appear if there is an error on the page after you click "send." Remember to contact dkgcastep1@gmail.com if there are any questions.
DKG RECOMMENDING MEMBER INFORMATION
First name of DKG Member recommending this applicant *
Your answer
Last name of DKG member recommending this applicant *
Your answer
DKG Member Number
See DKG Member Card or contact Chapter Treasurer
Your answer
Email address of DKG member recommending this applicant *
Your answer
Phone number of DKG member recommending this applicant *
xxx-xxx-xxxx
Your answer
Greek chapter name (i.e. Alpha, Iota Nu) of DKG member recommending this applicant *
Your answer
Area number of DKG member recommending this applicant *
Have you verified that the applicant meets the eligibility criteria? *
All boxes must be checked for the applicant to meet the criteria.
Required
APPLICANT (NON-MEMBER) INFORMATION
First name of applicant *
As it should appear on the certificate and the award check.
Your answer
Last name of applicant *
As it should appear on the certificate and the award check.
Your answer
Have you received this award previously? *
Home address (line 1) *
Number, Street and/or Apartment/Unit #
Your answer
Home address (line 2) *
City, State Zip Code
Your answer
Personal phone number *
xxx-xxx-xxxx Home or Cell
Your answer
Personal email address *
Please check accuracy as this is how recipients will be notified.
Your answer
Name of school and district *
Your answer
School address (line 1) *
Number and Street
Your answer
School address (line 2) *
City, State Zip Code
Your answer
School phone number *
xxx-xxx-xxxx
Your answer
Years of experience in the field *
Include all full-time positions, including the current year.
What materials will you be purchasing with this grant? *
Required
This grant will be used to *
Required
Briefly tell how the materials will be used in your classroom. *
Your answer
Amount requested *
PLEASE NOTE: The recipient may receive an award for an amount up to, but not exceeding $200. Enter whole number only. Do not include the $ symbol.
Your answer
VERIFICATION OF USAGE OF FUNDS *
Required
PHOTO/VIDEO RELEASE STATEMENT: *
If awarded, I grant my permission to be photographed, filmed, videotaped or audio-taped, and grant full use of my likeness, name, voice, and words without compensation for use on the California State Organization Website and for Society's other promotional purposes.
A copy of your responses will be emailed to the address you provided.
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