ZETA STATE LEADERSHIP/MANAGEMENT SEMINAR
Members of Zeta State are invited to apply for the Zeta State Leadership/Management Seminar to be held
June 14-17, 2015. No fewer than sixteen (16) and no more than twenty (20) participants shall be selected.
If there are fewer than 16 applicants, the seminar will be cancelled.
Exciting workshops are being planned on a variety of topics, including communication skills,
professional image, goal-setting, women and the law, and personality analysis. Well qualified,
professional presenters will lead informative and interesting sessions to help you develop your
personal and professional leadership skills.
Each seminar participant will pay a registration fee of $75.00. Other expenses will be paid by
Zeta State. Participants will be housed and all meals will be provided.
Selection criteria include membership in good standing; evidence of active participation in the
work of the Society commensurate with length of membership; and willingness to use acquired
skills for the benefit of the Society and education. Age will not be a factor in the selection
process. The Leadership Development Committee will make the selection of participants. All
applicants will receive notification of their status—accepted, not accepted, or placed on an
alternate list.
The seminar will be an informative and enjoyable growth experience for Zeta State members.
Interested persons should complete and submit the application, following carefully the
instructions given on the Application Process page.
Zeta State Leadership/Management Seminar
Approved April 2005
Revised October 2014
Leadership Management Seminar Application Process
1. Complete the application (Form 11, Revised October 2014). Applications may
be computer generated but must follow the format of the attached form.
2. Give the recommendation form to your chapter president, immediate past chapter
president, or chapter president’s designee. This form should be included in the
mailed application.
3. Send the application and recommendation forms and a check for $75.00 payable
to Zeta State* by April 1, 2015, to the chairman of the Zeta State Leadership
Development Committee:
Karen Fayard
778 Whitney
Biloxi, MS 39532
COMPLETE INFORMATION IS VITAL TO YOUR APPLICATION.
THANK YOU FOR YOUR CLOSE ATTENTION TO THE DETAILS OF
THIS PROCESS.
*If you are not selected for the seminar, your $75.00 check will be returned to you.
If you are selected for the seminar, no refunds will be made after the seminar
participants are announced.
Zeta State Leadership/Management Seminar
Approved April 2005
Revised October 2014
Form 11
Zeta State Leadership/Management Seminar Application
Page 1 of 4
Application for 2015 Zeta State Leadership/Management Seminar
The Delta Kappa Gamma Society International
Please type or print. Use additional sheets if necessary.
_____________________
Date of application
Ms.
Miss
Mrs.
Dr. __________________________________________
First name
Middle
Home Phone __________________
Bus. Phone__________________
Last
Street Address_____________________________________
Fax number ___________________
City, State, Zip _____________________________________
E-mail _______________________
Chapter________________________________ Date of Initiation_____________________________
EDUCATION
College or University
Location
Degree
Date
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
SOCIETY INVOLVEMENT
Offices_________________________________________________________________________________________
_______________________________________________________________________________________________
Committees_____________________________________________________________________________________
_______________________________________________________________________________________________
Other Services___________________________________________________________________________________
Conventions Attended: (Give year(s) of the meeting(s))
District____________________________________ Regional Conference_______________________________
State______________________________________ International Convention____________________________
Approved April 2005
Revised October 2014
Form 11
Zeta State Leadership/Management Seminar Application
Page 2 of 4
PROFESSIONAL EXPERIENCE
Current/Previous employer
____________________________
City
Title
_____________________
______________________
Years
_________
Major Responsibilities_____________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
PROFESSIONAL AND COMMUNITY INVOLVEMENT/AWARDS
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
In what ways will you be willing to share with other members of Zeta State and with your chapter and district the
skills acquired at this Seminar?
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Name three characteristics that best describe you (three words only).
a._______________________ b.______________________ c. ._______________________
Additional significant life experiences not covered elsewhere (please be specific).
_______________________________________________________________________________________________
_______________________________________________________________________________________________
_______________________________________________________________________________________________
Approved April 2005
Revised October 2014
Form 11
Page 3 of 4
For office use only:
Postmark Date:__________
ID Number: _____________
THE DELTA KAPPA GAMMA SOCIETY INTERNATIONAL
ZETA STATE LEADERSHIP/MANAGEMENT SEMINAR
RECOMMENDATION FORM
Please type or print.
Ms.
Miss
Mrs.
Dr. __________________________________________
First name
Middle
(Applicant’s Name)
Last
Ms.
Miss
Mrs.
Dr. __________________________________________
(Referent’s Name)
First name
Middle
Last
_________________________________________________________________ (Referent’s Address)
Street/P.O. Box
________________________________________________________________
City
State
Zip
Business Phone____________________________ Home Phone_____________________________
1. How long have you known the applicant?
_______________________________________________________________________________
_______________________________________________________________________________
2. From your point of view, what are the applicant’s principal strengths?
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
3. What has the applicant done to evidence leadership potential or professional competency to be
endorsed for this award? (Be specific.)
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
4. Rate this applicant in comparison to other professional educators:
Outstanding
_____
Average
_____
Superior
_____
Not able to determine
_____
Good
_____
(Please explain below)
______________________________________________________________________________
______________________________________________________________________________
Approved April 2005
Revised October 2014
Form 11
Page 4 of 4
5. In addition to the information indicated above, we would appreciate any additional comments that
you might share to assist with the selection process.
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
_______________________________________________________________________________
Complete the following as applicable:
CHAPTER PRESIDENT
(Or Immediate Past President or President’s Designee)
___________________________________
(Print or Type Name)
___________________________________
(Signature)
___________________________________
(Title)
___________________________________
(Date)
MAIL RECOMMENDATION FORM TO:
Karen Fayard, Chairman
Zeta State Leadership Development Committee
778 Whitney
Biloxi, MS 39532
DEADLINE: POSTMARKED NO LATER THAN APRIL 1, 2015
THANK YOU FOR YOUR INTEREST
The Delta Kappa Gamma Society International
promotes professional and personal growth of
women educators and excellence in education.
Approved April 2005
Revised October 2014