Alpha Chi Chapter (CT)

Distinguished Service Award

Please Note:  The Distinguished Service Award will not be awarded this year


Purpose:

 To recognize a member of Epsilon Sigma Phi who has contributed significantly to Extension program
planning and delivery.

NAME:________________________________
TITLE/POSITION:_______________________________
COUNTY/DEPARMENT:_____________________________________
NUMBER OF YEARS EMPLOYED BY C.E.S.:____________
YEARS IN PRESENT POSITION:_____________________
MEMBERSHIP IN EPSILON SIGMA PHI: _____YES  ____NO

Describe oustanding achievements of this nominee (use back if necessary):
 
 
 
 
 
 
 
 
 
 
 
 

Name of person submitting this nomination_______________________________ Date___________

Please submit application by December 1st, 2008 to:
Mary Ellen Welch
Middlesex County Extension Center
1066 Saybrook Road, Box 70
Haddam, CT 06438-0070

860-345-5214
Email: mary.welch@uconn.edu

Form revised 11/2008