Outstanding CSR of the Year
Competition Entry Form…continued.
Deadline for receipt of
all materials is
May 1st
Education/Involvement/Achievement (attach additional paper if needed)
Please print or type.
Formal Education
Insurance-Related Education (within last 2 years)
Insurance Awards/Honors/Affiliations (within last 2 years)
Community Involvement/Awards/Honors (within last 2 years)
Significant Contributions to Business/Coworkers (within last 2 years)
Return this form with completed essay to:
Kansas Association of Insurance Agents • 815 Southwest Topeka Blvd. • Topeka, KS 66612
785-232-0561 • Fax: 785-232-6817 • Email: [email protected] • Deadline for receipt of all materials is
May 1, 2016.
Awards
Nominees will compete first on a state level. Each state winner will automatically be entered into the national competition.
State Winners: Framed Certificate of Achievement; state recognition; advancement to national competition
4 National Finalists: $500 cash award; national recognition; gold and garnet pin
National Award Recipient: $2,000 cash award; gold and diamond pin; employer receives a scholarship to a National Alliance
program; nominator receives a $1,000 cash award
2586-0116 KS
|January-February 2016| KANSAS INSURANCE AGENT & BROKER
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