Alpha Chi Chapter (CT)

Friend of Extension Award

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Purpose:

 To recognize a non-staff person who has given outstanding public service and support to Extension.

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

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

Name of person submitting this nomination_______________________________ Date___________