Alpha Chi Chapter (CT)

Meritorious Support Service Award

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Purpose:

 Nominees must have demonstrated significant support and assistance for Cooperative Extension. Here is a chance
to nominate a support staff member, program assistant, secretary, clerical worker, or janitor.

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 outstanding achievements of nominee (use back if necessary):
 
 
 
 
 
 
 
 
 
 
 
 

Name of person submitting this nomination_______________________________ Date___________