Advanced Leader Award Application - Free Download
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Advanced Leader Award Application
Advanced Leader Award Application
PLEASE PRINT OR TYPE:
Member No. Club Name & No. ________________________________________ District ___________
Name ___________________________________________________________________________________ Date __________________________
Permanent Address Change
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Yes
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No
Address 1 _______________________________________________________________________________________________________________
Address 2 _______________________________________________________________________________________________________________
City _________________________________________________ State/Province ________________________ ZIP/Postal Code _______________
Country ______________________________________ Email Address______________________________________________________________
Phone _________________________________________________________________________________________________________________
Complete all requirements before submitting award applications to World Headquarters. Check award for which you are applying.
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Advanced Leader Bronze (complete Section I)
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Advanced Leader Silver (complete Section II)
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Distinguished Toastmaster (complete Section III)
ADVANCED LEADER/DISTINGUISHED TOASTMASTER (AL) (DTM)
AWARD APPLICATION
REV. 5/2014      ITEM 1228
I . Advanced Leader Bronze (ALB)
4 Achieved Competent Leader (CL) award
for completing Competent Leadership manual Date ______________ Club/District No. ___________________
4 Achieved Competent Communicator (CC) award
(or achieved Competent Toastmaster award) Date ______________ Club/District No. ___________________
4 Served at least six months* as a club officer (president, vice president education, vice president membership,
vice president public relations, secretary, treasurer, or sergeant at arms) and participated in the preparation of a
Club Success Plan while serving in this office.
(* You must have served as an ocer from July 1 through December 31 or January 1 through June 30 to fulll this requirement. Other six-month
periods do not qualify. The six months must be completed at the time you submit this application.)
Office held ______________________________________________________________ in Club No. _______________
Served six months as follows (check one and fill in year)
______ July 1 – December 31, ______ ______ January 1 – June 30, ______
Date you helped prepare a Club Success Plan for your club ________________________ ____________
(must coincide with above officer term)
4 While serving in above officer term, participated in a district-sponsored club-officer training program.
(Applicants in undistricted clubs need not complete this requirement.)
Date attended training _________________________________________________________________________________
DTM APPLICANTS MUST PROVIDE A STREET ADDRESS, NOT A P. O. BOX
MONTH YEAR
REQUIRED FOR DTM APPLICATIONS
TO APPLY:
You must be a current member of the club listed below at the time your application is received at World
Headquarters to be eligible for the award.
4 Complete both sides of this application.
4 A current club officer must sign and date the application.
4 Ask a current club officer to submit your application online at www.toastmasters.org/members.
If no current officer has online access, mail OR fax (one method only please) the completed form to:
Member Services - Education Awards Fax: 949.858.1207
Toastmasters International
P.O. Box 9052, Mission Viejo, CA 92690 USA
PLEASE PRINT OR TYPE (AS YOU WOULD LIKE IT TO APPEAR ON CERTIFICATE)
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