Form Option 1: Print out the form and complete by typing or printing in blue or black ink.
Form Option 2: Complete this form on-screen. Do not add extra lines in the form.
Georgia Association of Family, Career and Community Leaders of America
Application for Student Members of the
State Officer Selection Committee
(Must be from Region 1, 2, 3, 4, 7, 8 or 9)
Return completed form by February 15
If selected, you must be willing to attend an:
Orientation Meeting - Thursday, March 14 4:45pm (Headquarters)
Voting Delegates Interviews - Thursday, March 14 5:15-5:45pm (Athena F)
State Officer Interviews - Friday, March 15 8:00am – 12:00pm
Georgia Region: ___ Region 1 ___ Region 2 ___ Region 3 ___ Region 4
___ Region 7 ____Region 8 ___ Region 9
Chapter Adviser (s)
Number of years in
Family and Consumer
Number of years in
Current Grade Level
Major Contributions/Accomplishments in FCCLA
Power of One Units Dates Completed
A Better You
Take the Lead
Working on Working
Speak out for FCCLA
5 Unit State/National Recognition
Projects and Meetings Dates Completed or Attended
STAR Events or State Events
Attended FCCLA Summer Leadership Camp
Attended B.A.S.I.C. Training
Attended Fall Leadership Rally
Attended Leadership Conference
Attended Region STAR Events
Attended State Leadership Meeting
Served as a Voting Delegate at State Meeting
Attended FCCLA Day at the Capitol
Attended National Cluster Meeting
Participated in Georgia National Fair FCCLA
Events (Knowledge Bowl, Booths, Chili Cook-off,
Culinary Arts, Brochure)
Participated in Leadership Conference Events
(Membership Recruitment, Lapel Pin, T-shirt Design)
Recommendation letter should briefly attest to the applicant’s maturity, fairness,
trustworthiness, leadership ability, ability to assume responsibility, ability to work with
people they do not know, interest in FCCLA and Family and Consumer Sciences, and
understanding of the role of a State Officer.
Attach recommendation from the following:
1. Family and Consumer Sciences Teacher
Being a State Officer Selection Team member is a responsibility that requires firm
commitment and cooperation. State Officer Selection Team members are expected to:
Read all material sent to the State Officer Selection Committee in advance of
State Leadership Meeting.
Attend a State Officer Selection Committee Orientation/Training on Thursday
Attend the Voting Delegates Round Robin Interview Session with State Officer
Candidates on Thursday March 14.
Attend the State Officer Selection Team meeting with candidates on Friday
Use an objective rubric (provided) to evaluate the candidates for State Office.
Maintain confidentiality before during and after the selection process.
Approach the responsibility with seriousness and fairness.
The undersigned certify that the above candidate for State Officer Selection Team is
qualified for position and has approval to hold the position if selected.
Chapter Adviser Date
Technology/Career Supervisor Date
School Principal Date
Send completed application by February 15th to:
Georgia FCCLA 283
Swanson Drive Suite 204
Lawrenceville GA 30043