The Roy D. Graham Lifetime Achievement Award
Presented by District ONE Toastmasters
Please read the rules for complete details. . Complete the following application to be considered for the Roy D. Graham Lifetime Achievement Award. Email your completed application to Sandy Dunning DTM, PDG at by Friday September 15, 2017. Winners will be announced at the 2017 Fall Conference on Saturday, November 4, 2017.
Individuals, who have completed the certification requirements more than once, only need to document one of each level of certification to be eligible. Additional certificate registrations, District positions, Club memberships, and presentations should be listed on a separate sheet.
Please type or print
NamePhone / Email
Date Joined / Current
Home Club / Member of
District ONE Since
Section 1 – Educational Eligibility
Applicants must have achieved the DTM designation.
Registration Number(If Applicable) / Date of Registration / Club Receiving Credit
DTM
Section 1A: If you received your DTM prior to July 1, 1999 list registration dates for at least one of the following options:
Registration Number(If Applicable) / Date of Registration / Club Receiving Credit
Option 1-an additional:
Able Toastmaster Bronze and
Able Toastmaster Silver
Option 2-an additional:
Advanced Toastmaster Gold
Section 1B: If you received your DTM after July 1, 1997 list registration dates for at least one of the following:
Registration Number(If Applicable) / Date of Registration / Club Receiving Credit
Additional CTM or CC
Additional ATM or AC
Section 2 – Additional Presentations and Seminars (New System only)
Section 2A: If you achieved your DTM under the “Old System” (earned before July 1, 1999) skip to section 3. “New System” DTMs (earned after July 1, 1997)must list 10 additional Toastmasters presentations or seminars beyond those given to achieve your DTM. The following qualify: Keynote or similar speech at District, Regional or International Conference/Convention, Educational Seminar or Workshop at Area level or above including District-sponsored Club Officer Training or Leadership Institute, Success/Leadership or Success/Communication modules, or Youth Leadership.
Description of Presentation / Registration Numbers(If Applicable) / Date / Club Receiving Credit
(If Applicable)
1
2
3
4
5
6
7
8
9
10
Section 2B: If you achieved your DTM under the “Old System” (earned before July 1, 1999) skip to section 3. “New System” DTMs (earned after July 1, 1997) must list 4 presentations to non-Toastmasters audiences that can be work or community related.
Description of Presentation / Audience Type / Date / Club Receiving Credit(If Applicable)
1
2
3
4
Section 3 – Membership Eligibility
The applicant must have at least ten consecutive years in Toastmasters before July of the year the award is presented - at least five of which shall be in District ONE. List the required information below as it relates to the last 10+ years of membership.
District / Club Name and Number / Period of Paid MembershipSection 4 – Leadership Eligibility
Applicants must serve at the district level in District ONE beyond that required for DTM (must be completed within the qualifying ten years of membership). Under the “old DTM” system you need one additional year of District level service and under the “new DTM” system, you’ll need two additional years of District level service. The following qualify: District Executive Committee member or serve as a Committee Chairman appointed by the District Governor. List the required information below as it relates to additional leadership service.
Position / Year / Appointed by (if applicable)1
2
Section 5 – Other
List any notable accomplishments you’ve had and the results on the District. Also include your involvement in any clubs, Areas, Division or District activities. Use a separate sheet for more space.
I have read and understand the rules for eligibility. To the best of my knowledge, I certify that the above information and any information attached is correct concerning my involvement with Toastmasters International.
Signature of Applicant Certifying EligibilityDate
revised 09/2013Page 1 of 2