2010 PRSA COLLEGE OF FELLOWS APPLICATION/CANDIDATE INFORMATION SHEET
Candidate Name Date
Title
Organization
Address
City, State, Zip Code
Work Phone: Fax
Mobile: Home Phone:
This is a re-application.
Note: Only check this box if you applied last year. If you applied last year, see application instructions for specific requirements for reapplying. If you applied more than one year ago, consider this a NEW application.
Year your public relations career began
PRSA Chapter membership(s)
PRSA Section membership(s)
Check here if you are not a member of a PRSA Chapter or Section
Name of person (if applicable) who nominated you with letter of nomination:
Telephone: Mobile:
E-mail Fax:
Address
Names, addresses, and telephone and fax numbers of those six individuals submitting letters of nomination/recommendation, as noted in the instructions, including at least three letter writers from inside the public relations profession, at least one person from outside public relations and your Chapter president or Section/District chair assessment, which should accompany the Chapter/Section/District Comment Form.
These letters should be sent directly to the College of Fellows Selection Committee. Mail to: PRSA,33 Maiden Lane, 11th Floor, New York,N.Y.10038-5150. Fax or e-mail to: Heather Ritchey, (212) 460-5900. Note: if e-mailing, all letters must be provided on business letterhead or personal stationery, must have an original signature and should be scanned and attached as PDF documents. E-mail messages without the required attachmentswill not be considered. All letters are due no later than Thursday, May 6, 2010, by 5 p.m., Eastern Time.
[Note: Re-applicants in consecutive years need only three additional letters, one from outside the profession, two from within.]
The following list should match the names on the letters received on your behalf at PRSA. Additional letters will not be submitted to the Selection Committee for consideration. Letters of support must be submitted on business letterhead or personal stationery that clearly identifies the writer and provides contact information.
1. Name: Phone:
Fax: Mobile:
Address E-mail
2. Name: Phone:
FaxMobile:
Address E-mail
3. Name: Phone:
Fax: Mobile:
Address E-mail
4. Name: Phone:
Fax: Mobile:
Address E-mail
5. Name: Phone:
Fax: Mobile:
Address E-mail
6. PRSA component leader writing your assessment letter and submitting your Comment Form
Name: Phone:
Representing Chapter/Section/District
Fax: Mobile:
Address: E-mail
I hereby submit this application for induction into the College of Fellows. The information contained in this application is true and accurate. (When nominating someone for Fellowship, you must obtain the nominee’s signature attesting that the information submitted is correct.)
By applying for identification as a Fellow, I agree, if I am inducted into the PRSA College of Fellows, to serve wherever possible; to respond when called upon by the Chair of the College; and to perform any tasks that are clearly intended to advance the state of the public relations profession on behalf of the College and the Society.
SIGNATURE OF APPLICANT (or NOMINEE)DATE