Virginia Dietary Managers Scholarship Application

Check One:                  Current Member Continuing Education Scholarship                ?

       Student Member Scholarship                                                 ?

1.  Virginia Chapter will award one (1) - $300 scholarship to a student member and two (2)- $300 scholarships     to current members to be used for the Fall State VDMA Conference. 

2.  Scholarship applications are based on the 2011 calendar year activities.

3.  Complete the enclosed application and return to Julie Hobbs, postmarked or emailed no later than

   March1, 2012. Applications can be e-mailed Julie.hobbs@vadoc.virginia.com or mailed to:

                          Address: Brenda Jean Golas, CDM CFPP

                                         22 Willow Lane

     Stafford, VA 22554           

4.  The winners will be notified by email or phone on March 5, 2012.

5.  Authorized reimbursable expenses include only the following areas:

       a. Conference registration.

       b. Hotel: (room rate, parking).

       c. Travel expenses (most economical method).      

6.  Scholarships will be awarded to the one (1) student member and two (2) members receiving the highest

scores based on the designed score sheet. In case of ties, scholarships will be reviewed and determined by a non-partial authority.

7.  National Scholarship and Award winners will not be eligible for Virginia Chapter Scholarship.

8.  The Virginia Chapter Treasurer/Secretary will issue scholarship checks upon presentation of Original

      receipts up to $300.00.

Name: ______________________________________________________________                   

Facility: ______________________________________________________________                                                                               

Work phone:    ______________________________________________________________                   

Home/Cell phone: ________________________________________________________                   

Mailing address: ____________________________________________________________                      

                           ____________________________________________________________

Please indicate if you have applied for funding from any other source.  ______Yes ______ No

If yes; list sources and type of funding requested.  _______________________________________

_______________________________________________________________________________

Signed: ____________________________________ Date:_____________________        

Documentation for Virginia Chapter Scholarship

District Activities 2011

1. Attendance at Virginia District Meetings:

Please list meeting Dates that you have attended this year:

2. Host Virginia District Meeting:

Please list meeting date and location

3. Serve as a District Officer:

Please list office held and dates held

4. Design and facilitate training for a District Meeting:

Please list date of meeting and title of training. Include program

5. Serve as a District Committee Member:

Please list committee

6. Write an article for the Chapter newsletter:

      Please include newsletter or a copy

State Chapter Activities 2011

1. Attendance at Virginia Statewide Chapter Meetings (Spring, Fall):

Please list meeting Dates that you have attended this year:

2. Serve as a State Officer:

Please list office held and date of installation

3. Design and facilitate training for a State Meeting:

Please list date of meeting and title of training. Include program

4. Serve as a State Committee Member:

Please list committee

5. Write article for Dietary Manager’s Magazine:

      Please list title of article and the issue and date

6. Achievement of the following within the calendar year ”2010”:

Please include documentation of the achievement of any of the following and the date achieved

CDM –

CCFP –

College Degree (specify)

            Any recertification

Bonus Activities 2011  

1.      Bonus Points:  Achievement (include documentation for review)/awards or recognition.