ALPHA CHAPTER-WEST VIRGINIA
PROFESSIONAL WORKSHOP/SEMINAR/COURSE WORK SCHOLARSHIP APPLICATION
Please print to type all information on this application. The application is due by February 1st or May 1st.
I. PERSONAL DATA
Name of applicant_____________________________Ms.,Mrs.,Dr.
Date of initiation_________________
Address_________________________________________________________
II. PROFESSSIONAL EXPERIENCE
A. Number of years of professional experience____________________
B. List in chronological order the teaching positions you have held. Include all teaching, supervisory, and administrative positions.
Institution City Dates Position
______________________________________________________________________________________ _______________________________________________________________________ _________________________________________________________________________________________
III.SERVICE TO DELTA KAPPA GAMMA SOCIETY INTERNAITONAL
A. Number of years you have been a member of the Society______________
B. List chapter and state committees on which you have served.
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
C. List chapter and state chairmanships you have held.
________________________________________________________________________________________________________________________________________________________________________________
D. List chapter and state offices you have held.
________________________________________________________________________________________________________________________________________________________________________________
IV. WORKSHOP, SEMINAR, COURSE WORK INFORMATION.
A. Name/date of seminar, workshop or course attended
_____________________________________________________________
B. Indicate plans for use of information gained
________________________________________________________________________________________________________________________________________________________________________________
V. AMOUNT REQUESTED (be sure to attach receipts)
VI. Signature of applicant _____________________________________
Date submitted_____________________________________________
Decision of committee_____________________________________
Date reviewed______________________________________________
2020-2022
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