SENATORIAL DEGREE APPLICATION—Deadline: March 25

Candidate's Name __________________________________________

Home Mailing P.O. Box or Street _

________________________________________________________________________
City State ZIP

Chapter

Grade Level

Years of Technology Education completed

Date you became a TSA member

Date received Congressional Degree

Have you had continuous active membership since you first became a member?

List date(s) you attended a TSA Fall Leadership Conference

List the local TSA chapter committees on which you have served

List the date(s) in which you attended and competed at the TSA State Conference:

Year Competitive Event

List all chapter offices that you have obtained or attempted

Grade Point Average (overall) Overall Technology Education GPA

Give a brief summary of your presentation about TSA and/or Technology Education. (Please explain where the presentation was made and provide the date.)

The above-named TSA member has completed these requirements and we certify these accounts to be true and accurate.

__________________________ _______________________________
Advisor's Signature Candidate's Signature

Chapter President School Principal