EmailMe Form - USWT Intent to Extend

USWT Intent to Extend

Complete this form when a decision has been made to work on extending a new Women of Today Chapter. Use this form only if your state does not have your own Intent to Extend.

This form requires the signature of the Chapter President and Extension Chair; be sure that both are present when completing it. Signatures can be done by your mouse, or your finger on a writable screen.

Responses to the online form will be viewed by the USWT Extension Director, USWT Membership Vice President, and your state contact. Fill in as much information as you know. Upon completion of the form, click Submit; you will receive a confirmation screen if your form has been successfully submitted. (rev 2019)

Your Email *
Submitter Name *
First Last
Date Submitted *
MM / DD / YYYY
State *
Other State *
If you are a member of a state organization not listed, please enter your state.
Chapter *
Community Name *
Population Number *
Distance from your Community to Extension *
Extension Chair Name *
First Last
Phone
### - ### - ####
Address

Street Address City State / Province / Region Postal / Zip Code
Extension Contact Information *
Have any contacts been made? Summarize any phone calls or meetings that have been held.
What plans have been made? *
List any meetings that are set up, public relations plans, phoning to be done, etc.
Do you need a USWT Extensions Manual? *
Yes
No
This manual gives suggestions on how to proceed with your Extension.
Do you need a USWT Extension Media Kit? *
Yes
No
This kit has ample posters, invitations, announcements, Public Service Announcements, and is copy-ready for use in Extensions work.
Extension Completion Date *
MM / DD / YYYY
Enter the proposed date for completion of Extension
Is your chapter willing to work with the new chapter for a full year after it receives its charter? *
Yes
No
Chapter President Signature *
Clear
Extension Chair Signature *
Clear