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ALTRUSA INTERNATIONAL, INC. DISTRICT SIX                                                      

Rookie of the Year Award

Nomination Form

Please print or type all information.  The back of this sheet may be used for additional information.

Nominee’s name: __________________________________ Altrusa International, Inc. of _______________________________

Address _______________________________________ City ________________________State ____ Zip ________________

Nominee has been a member of Altrusa International, Inc.?                                 (Must be a member as Altrusan within the three calendar years before conference (e.g. after 04/01/09.)

Activities since becoming an Altrusan:

Positions held in Local Club (with dates) _______________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

_______________________________________________________________________________________________________

 

District Conference

(enter years):

>>> 

Attended

 

As Delegate

 

As Alternate

­­­­­­­­­­­­­­­­

Int. Convention

(enter  years):

>>> 

Attended

 

As Delegate

 

 

As Alternate

 

 

 

Presentations (give titles & dates):   Program to Club _____________________________________________________________

 Workshop done____________________________________________________   No. of new members sponsored ___________

Write brief description of major projects chaired by nominee_______________________________________________________

 _______________________________________________________________________________________________________

 _______________________________________________________________________________________________________

 Write brief description of minor projects chaired by nominee________________________________________________________

 _______________________________________________________________________________________________________

 _______________________________________________________________________________________________________

 Activities during the past year:

No. of Club Meetings Held:

No. Attended by Nominee:

No. of Community Service Hours by Nominee:

No. of Member Service Hours by Nominee:

No. of  Other Volunteer Hours by Nominee:

 

Member of Club 21:  No____ Yes ____ Years________ Donations to Altrusa Int. Foundation:  No___Yes____ Years__________

Please complete a 500 word essay about this nominee and send it with the completed information.  Include how they have demonstrated leadership as an Altrusan and made a difference to Altrusa.

Entry must be postmarked by March 10, 2012 and returned to:  Toni Ellis, 1912 Williamsburg Road, Lexington, KY, 40504-3014 or emailed to Toni_ellis2001@hotmail.com

Date:                                       Altrusa International, Inc. of: ___________________________________

                                                 Submitted by: _______________________________________________