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Springboard Form

A great step has been taken by learning about the Junior Chamber and becoming an active and productive member. The final step is to complete the information requested below. Give the completed form to the Chapter President to sign.

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76 views1 page

Springboard Form

A great step has been taken by learning about the Junior Chamber and becoming an active and productive member. The final step is to complete the information requested below. Give the completed form to the Chapter President to sign.

Uploaded by

api-3764743
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as PDF, TXT or read online on Scribd
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THE UNITED S TATES JUNIOR CHAMBER ©

Revised 11/01

Springboard Program
CERTIFICATION FORM
Congratulations on completing the USJC Springboard Program! A great step has been taken by learning about the
Junior Chamber and becoming an active and productive member. The final step is to complete the information requested
below. Give the completed form to the Chapter President to sign.
PLEASE RETURN THIS FORM TO THE STATE OFFICE.
Name ______________________________________________________________________________________________

Address _____________________________________________________________________________________________

City _____________________________________________ State ____________________ ZIP _____________________

Home phone______________________________________ Work phone_________________________________________

Fax ______________________________________ E-mail address ______________________________________________

Chapter name ______________________ Chapter number ____________ State name ______________________________

Chapter address ______________________________________________________________________________________

City _____________________________________________ State ____________________ ZIP _____________________

Chapter President _____________________________________________________________________________________

Home phone _________________________________ E-mail address ___________________________________________

ACTIVITIES COMPLETED (Must complete 18 requirements):


MANDATORY (All requirements must be completed):
Date Completed
1. Attend 50 percent of the chapter’s membership meetings. Missed meetings can be made
up by attending the chapter Board of Directors meetings or meetings of another chapter. _____________
2. Be able to recite the Jaycee Creed. _____________
3. Participate in a Speak-Up program. _____________
4. Recruit one new member. _____________
5. Serve as an active member of a community service/fundraising project. _____________
6. Attend a chapter new-member orientation. _____________
7. Renew membership in the Junior Chamber of Commerce. _____________
8. This item may be an activity decided by the chapter. _____________

OPTIONAL (Please list the 10 activities, determined by the chapter, that have been completed):
Date Completed
1. _________________________________________________________________________ _____________
2. _________________________________________________________________________ _____________
3. _________________________________________________________________________ _____________
4. _________________________________________________________________________ _____________
5. _________________________________________________________________________ _____________
6. _________________________________________________________________________ _____________
7. _________________________________________________________________________ _____________
8. _________________________________________________________________________ _____________
9. _________________________________________________________________________ _____________
10. _________________________________________________________________________ _____________

Academy Member Assigned to New Member:


Name ___________________________________________ Academy member’s I.D. # _____________________________

Chapter President’s signature of verification _______________________________________________________________

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