Application Procedure

1. Submit this Intent to Apply form by July 15 of current year.

2. Submit your completed proposal by September 15 of current year.

Name of Council ________________________________________________

Name of Contact Person __________________________________________

Work Address:  _________________________________________________

________________________________________________________

Work Phone Number_________________ Fax  ______________

Home Address:  ________________________________________________

________________________________________________________

Home Phone Number: ___________________________________________

Email address ____________________________________________

Submit this form to:
                     Jean Workman
                        P. O. Box 3610
                        Shepherdstown, WV  25443
 

STATEMENT OF AGREEMENT:  We hereby attest that if our request is accepted for judging from the Cynthia Lorentz-Cook Memorial Award for the current year,  the request will be carried out as written.  Additionally, following implementation of the request, we agree to submit a report detailing the steps utilized to carry out the request, and its overall effectiveness as a council/member activity by the first year anniversary date of the award.

President (signature) ___________________________________________

Vice President (signature)  ______________________________________