The Penne Ferrell Fund Literacy Award Application Due November 1
The Delta Kappa Gamma Society International ~ California State Organization ~ Support Team for Emerging Professionals
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 chistateece@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.
Provide a brief description of what this award will fund.
PLEASE NOTE: The award is intended to finance the cost of books, e-books or reading apps. These reading resources are intended to supplement curriculum or to enhance a classroom library. Minimum 1000 characters.
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.
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