xt
Jim Jurek Memorial Award

C.Award Submission Form

1.Award is to be given at the Year End Convention.

2.Eligible Statesman Shall Be In Good Standing. Eligible Statesman cannot hold a position with the Minnesota Jaycees, examples State President, Vice Presidents, Program Managers, Regional Directors, District Directors, Chapter Presidents, Chapter State Delegates, or a member of the Statesman Board of Directors   all other chapter positions shall be eligible.  The honor can be awarded to a Statesman that is not currently of Jaycee Age but the Jaycee is in good standing with the Statesman Organization.

3.The Award submission shall consist of, Award submission form, Write-up, and two letters of recommendation from Statesman one may be from the honorees home chapter, one must be from outside their home chapter.  If honoree is not currently associated with a chapter the letters must be from Statesman associated with two different chapters.   Letters of recommendation from Honorees Employer, Church, and other interest are encouraged but not required. 

4.Award Submissions Shall be postmarked or received no later then one month before the Year End Convention, If The Statesman President Permits Applications, and Letters of recommendation can be e-mailed to the President no later then one month before year end convention.

5.The Judging panel shall consist of the Statesman President, one Statesman Board Member, and two Statesman Members at large that are not eligible for the honor, and do not have chapter members in the running for the award.


6.Criteria for the honor shall be. 
a.Statesman involvement with their home chapter
b.Statesman involvement in their Community (Church, Athletic Associations, Government, Other Charitable work outside Jaycees
c.Statesman involvement with other Jaycee chapters, (mentoring, recruiting, training, working events).
d. Statesman involvement with Minnesota Jaycee State Programs, (Priority Projects, Trainings, Children Sporting Events, Road-running, Conventions).
e.Statesman involvement with Statesman Programs, (Mentoring, Statesman sponsored competition, and fund raising events).
f.The criteria are meant to be a guideline of what the judges will be looking for only. A Statesman may be submitted if they do not meet some of the guidelines however, the more criteria that are meet the greater the chance of the Statesman shall be honored.			
 	   Jim Jurek Memorial Award Submission

Click On Box and Fill In

Name:							Chapter:  


Address									City:  					


State:			Zip: 			Phone Number: 				


Email:						Spouse Name:


Children Names:        	        

Statistics 
All questions asked here are for the current Jaycee Year.  They are to give the judges a quick snapshot of the Honorees activities during the Year.  We are aware that exact numbers may not be available; please use your best judgment when answering these questions.


Attends Local Chapter Meetings Percentage:			Chapter Events Worked:


Number Of District, Regional, State Events:			Chapter Events Chaired:


Number of New Member Signed:			Number Of Visitations to other Chapters:


Number of Statesman Projects Worked:			Chapter Name If Mentoring:


Jaycees Mentored Names:



Number Of Trainings Attended:			Number Of Trainings As a Trainer:


State Priority Projects Worked:			Judged Statesman Sponsored ID Projects:
       Jim Jurek Memorial Award Submission

This is the Essay Part of the write up please express why you feel this honoree is deserving of the Jim Jurek Memorial Award.




































Name Of Person Submitting:					Phone Number:


E-mail Address: