AD Interest Form - 2019-20 Question Title * 1. Are you interested in serving as an Area Director for District 39 Toastmasters starting July 1, 2019 to June 30, 2020? Yes No OK Question Title * 2. Contact Information Name Club name(s) City/Town State/Province -- select state -- AL AlabamaAK AlaskaAS American SamoaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareDC District of ColumbiaFM Federated States of MicronesiaFL FloridaGA GeorgiaGU GuamHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMH Marshall IslandsMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaMP Northern Mariana IslandsOH OhioOK OklahomaOR OregonPW PalauPA PennsylvaniaPR Puerto RicoRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVI Virgin IslandsVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY Wyoming ZIP/Postal Code Email Address Best Phone Number OK Question Title * 3. If you have a preferred area, please select the area number below: No preference at this time Area 01 Area 02 Area 03 Area 04 Area 11 Area 12 Area 13 Area 14 Area 21 Area 22 Area 23 Area 31 Area 32 Area 33 Area 41 Area 42 Area 43 Area 44 Area 51 Area 52 Area 53 Area 54 Area 61 Area 62 Area 63 Area 64 Area 71 Area 72 Area 73 Area 74 Area 81 Area 82 Area 83 Area 84 Area 91 Area 92 Area 93 Area 94 OK Question Title * 4. Have your ever received credit for a year of district service serving as any of the following: Area Director, Division Director, District Director, Program Quality Director, Club Growth Director, Finance Manager/Treasurer, Administration Manager/Secretary? Yes No OK Question Title * 5. Area directors have very important roles and responsibilities. Will you commit to completing all tasks listed below? Yes No Attend & complete Area Director training at the beginning of the year? Attend & complete Area Director training at the beginning of the year? Yes Attend & complete Area Director training at the beginning of the year? No Visit each club in the area (3-5 clubs) at least twice per year & submit an online report? Visit each club in the area (3-5 clubs) at least twice per year & submit an online report? Yes Visit each club in the area (3-5 clubs) at least twice per year & submit an online report? No Chair area council meetings at least twice per year? Chair area council meetings at least twice per year? Yes Chair area council meetings at least twice per year? No Chair the international speech contest in the Spring? Chair the international speech contest in the Spring? Yes Chair the international speech contest in the Spring? No OK Question Title * 6. Please check ALL officers roles where you have successfully completed at least 6 months of service and attended district sponsored officer training during your term in office. Club President Club VP Education Club VP Membership Club VP Public Relations Club Secretary Club Treasurer Club Sergeant at Arms None of the above OK Question Title * 7. From the current education system expiring June 30, 2020, please select the HIGHEST communication award you have achieved Competent Communicator (CC) Advanced Communicator Bronze (ACB) Advanced Communicator Silver (ACS) Advanced Communicator Gold (ACG) Distinguished Toastmaster (DTM) None of the above OK Question Title * 8. From the current education system expiring June 30, 2020, please select the HIGHEST leadership award you have achieved Competent Leader (CL) Advanced Leader Bronze (ALB) Advanced Leader Silver (ALS) Distinguished Toastmaster (DTM) None of the above OK Question Title * 9. Please select the highest Pathways education award you have successfully completed. Pathways Level 1 Pathways Level 2 Pathways Level 3 Pathways Level 4 Pathways Level 5 Pathways Distinguished Toastmaster (DTM) None of the above OK Question Title * 10. In addition to the education above, have you successfully completed and received a record of completion from Toastmasters International for any of the following: Yes No High Performance Leadership (HPL) module High Performance Leadership (HPL) module Yes High Performance Leadership (HPL) module No Coach a club with 8-12 members to a net gain of +5 additional members and achieved distinguished club status Coach a club with 8-12 members to a net gain of +5 additional members and achieved distinguished club status Yes Coach a club with 8-12 members to a net gain of +5 additional members and achieved distinguished club status No Sponsor a new club to establish a club charter Sponsor a new club to establish a club charter Yes Sponsor a new club to establish a club charter No Mentor a new club for initial six months of club charter Mentor a new club for initial six months of club charter Yes Mentor a new club for initial six months of club charter No OK Question Title * 11. In the box below, please explain how you plan to accomplish the tasks for the role, why you would be the best fit for the role, and why you want to serve as Area Director. OK DONE