2009 ESP Award
Nomination Form (Non-Team)

Complete the following information to nominate someone for an Epsilon Sigma Phi Award. Read the description of the award to find out about any specific information that may apply to that award. Include one black and white glossy photo of the nominee.

Personal Background Information

Full Name: ____________________________________

Current Address: ___________________________________________________________

____________________________________________________________

_____________________________________________________________

Birthplace: _______________________________

Birth date: _______________________________

Educational Background: (Chronologically list educational institutions attended and list dates of attendance and degree earned.

Employment: (Chronologically list employment with a special emphasis on employment record with Extension)

Award Category

____ State Certificate of Recognition

____ Outstanding Regional Extension Faculty (Woman)
____ Outstanding Regional Extension Faculty (Man)
____ Outstanding State Extension Faculty

____ State Friend of Extension Award
____ Distinguished Service Award
____ Mid-Career Service Award
____ State Early Career Service Award
____ State Retiree Service Award
____ State Meritorious Support Service Award
____ Team Award
____ Visionary Leadership

Professional Accomplishments: Include achievements and honors that particularly relate to Extension and/or subject competence; authorship of books, bulletins, articles, speeches; work on committees, task forces, study groups, etc.; special presentations at professional meetings and conferences; special leadership positions held (state, regional, national); contributions to professionalism through group and individual activities.

Program Accomplishments: Provide a summary of career highlights that explain clearly the professional and leadership role the candidate has/have play in planning, implementing, and/or administering strong Extension policies, procedures, programs, and trends at the state, regional, national, and if applicable international level.  Data supporting measurable impacts of the candidate's work in meeting needs of clientele will strengthen the nomination.

Support Statement: Develop a concise, well-written, easy-to-read narrative summary statement, which makes the best possible presentation of the candidate and puts everything in proper perspective.

When considering nominations the following point system will be used.

Followed information Guidelines            10 pts.

Program Accomplishments                     40 pts.

Professional Accomplishments              40 pts.

Support Statement                                   10 pts.

Nominations are due September 1, 2009.  Send nominations to Joe Koenen, Putnam County Extension Center, Courthouse Room 104, Unionville, MO 63565, or e-mail koenenj@missouri.edu

Last revised 2009-03-29

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Web Manager:  Bob Schultheis Webster County Extension Center Email comments to: schultheisr@missouri.edu Last revised: 07/22/10