ALABAMA CHAMPIONS APPLICATION FORM FOR …



ALABAMA CHAMPION APPLICATION FORM FOR RECOGNITIONAND 100% MEMBERSHIP APPLICATION FORM FOR RECOGNITIONAPPLICATIONS MUST BE POSTMARKED BY JANUARY 15. PLEASE PRINT OR TYPE YOUR INFORMATIONName of Chapter FORMTEXT ?????School Name FORMTEXT ?????School Address FORMTEXT ?????City/Zip FORMTEXT ?????School Phone ( FORMTEXT ?????) FORMTEXT ?????Adviser’s Name FORMTEXT ?????If more than one adviser, list all names FORMTEXT ?????Principal’s Name FORMTEXT ?????Previous Year Chapter Membership FORMTEXT ?????Present Year Chapter Membership FORMTEXT ?????We have met one of the requirements to become an Alabama Champions Chapter. Check the appropriate box. FORMTEXT ?????We affiliated* ten more members than last year. Documentation: Attach previous and current year’s paid affiliation receipts. FORMTEXT ?????We affiliated* as a new chapter (one that did not affiliate last year) with at least 15 members. Documentation: Attach copy of paid affiliation receipt. FORMTEXT ?????We affiliated* over 100 members. Documentation: Attach copy of paid affiliation receipt. FORMTEXT ?????We have 100% membership. (100% of your students are members of FCCLA) Documentation: Attach copy of class roster and paid affiliation roster. FORMTEXT ?????Total number of students enrolled in the FCS program. Documentation. Attach copy of class rosters. FORMTEXT ?????Total number of FCCLA members. Documentation: Attach copy of paid affiliation receipt.*Affiliated means the dues and membership affiliation form for FCCLA chapter has been received at national headquarters. Dues must be received in the national office and this application form must be emailed to the state office by January 15 to qualify for recognition.I certify the above information in this application is correct.Chapter President FORMTEXT ?????Date FORMTEXT ????? (Signature)*Chapter Adviser FORMTEXT ?????Date FORMTEXT ????? (Signature)*Send Alabama Champions Application and 100% Membership Application by February 15 to:Esther Hicks, ALAFCCLA State AdviserP.O. Box 302101Career and Technical Education/WFDMontgomery, Alabama 36130-2101Email: ehicks2@alsde.eduPhone: (334) 242-9113FAX: (334) 242-0234State Approved FORMTEXT ?????Date FORMTEXT ?????*May type in signature to use vie e-mail or print and sign for mailing or fax. ................
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