PHI DELTA KAPPA MEMBERSHIP REFERRAL BLANK 
 

Please print this form and complete it on or before November 21, 2006 and return to:

 

Debbie Brown                                                           
Harrison High School
Evansville, IN  47715                                                                                                                                       
 

I consider _____________________________________ a potential candidate for the Evansville Chapter of Phi Delta Kappa. 
 

The following points were considered in evaluating the potential candidate for membership: 
 

Home address:______________________________________________________________

Age:___________

Presently Employed__________________________________________________________ 
 

Educational Background:

Degree(s):____________________________________________________________ 
 

Years of Employment in the Field of Education:_________ Student: yes_______ no_______ 
 

Character Traits: (Include statements regarding candidate's honesty, dependability, standing among fellow workers, church participation, etc.) 
 
 
 
 
 

Educational Activities: (Comment on and list candidate's participation in professional organizations, committees, offices held, etc. Be specific.) 
 
 
 
 
 

Will you serve as the candidate's sponsor by being present at the orientation and initiation meetings: Yes________ No__________ 
 

Sponsor______________________________________________________________________

Co-Sponsor: (Mandatory)__________________________________________________________________ 
 

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