APPLICATION FOR JCI SENATOR MEMBERSHP

APPLICATION FOR JCI SENATOR MEMBERSHP

This application form is to be submitted together with the standard JCI Application form duly signed and completed. Please type the form and submit a copy to each of the Senate Screening Committee member. A recent photo of the applicant should be enclosed.

Certification by LOM President

I, the undersigned, being President of the Junior Chamber International______which is in good standing and financial with Junior Chamber International Hong Kong, I hereby certify that, to the best of my knowledge, the information contained in this application form is true and correct. I further certify that the applicant mentioned hereunder has been a bona fide member with our chapter for at least three consecutive years and has been considered a valued member worthy of recommendation for JCI Senatorship.

Upon notification of approval from the National President, my chapter agrees to contribute HK$4,000 (of which HK$2,340, equivalent to US$300 will be payable to JCI and the balance to Hong Kong JC Senate Fund).

Name of President: ______Signature : ______

Name of LOM : ______Date : ______

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Name of Applicant: ______

Occupation : ______

photo

Address of Applicant : ______

______

______

______

______

(Note :Relevant records or documents may help processing when submitting this form)

Applicant (* Please tick as appropriate) :

* / is currently a member of his/her chapter
Date of membership : ______
Day Month Year
* / has previously been a member of his/her chapter
Date of membership : ______
Day Month Year
Reasons for applicant ceased to be a member :
______
______
______
______
  1. State the positions held by the applicant with appropriate date, if any:

Year / Position / Remarks
LOM
NOM
JCI
  1. State any major participation by the applicant in projects (with proven document, if available) :

Name of Project / Year / Capacity / Remarks
LOM
NOM
JCI
  1. List applicant’s attendance at the following meetings and functions for the three most active years (Proof of attendance is desirable but not essential) :

Meetings and Functions

/ Year / Year / Year / Average Attendance
LOM / Monthly Meeting
Board Meeting (if applicable)
Others
(Functions/Activities)
NOM / Board meeting (if applicable)
Inaugural Ball
National Convention
Discussion Groups
Others
(Functions/Activities)
JCI / Year / City
Conference attended so far
Congress attended so far

Satisfactory reasons should be given in case he/her is not able to attain this attendance record.

______

______
______
______

______

  1. Specify the applicant’s contribution to LOM and/or NOM’s membership and extension program :

(A)Names of member/s introduced by the applicant (Any proven documents?):

Name

/ Year / Achievement
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2
3
4
5

(B)Has the applicant participated in any membership extensions project? If yes, please state details :

Name of Project / Year / Capacity

5.Describe applicant’s contribution in promoting the image of Junior Chamber:

______
______
______
______
______
______

6.State briefly applicant’s significant contributions, other than those mentioned above at LOM, NOM or JCI level :

______
______
______
______
______
______

  1. Other pertinent information :
    ______
    ______
    ______
    ______
  1. State other organization/s of which applicant is a member or officer :
    ______
    ______
    ______
    ______
  2. If awarded senatorship, would applicant continue to support Junior Chamber movement? State his/her possible contribution :
    ______
    ______
    ______
    ______
  3. List any awards/honours received by applicant :
    ______
    ______
    ______
    ______
    ______
    ______
  1. Please succinctly in the space provided summarize why you think the applicant should be awarded senatorship at this stage?
    ______
    ______
    ______
    ______

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