PDK International

Emerging Leaders Request for Information

Please submit this form prior to close of business on July 31. If you have any questions, please email emergingleaders@pdkintl.org or call Melanie Keller, 812-269-6624.

Please provide your full name as you would like it to appear on a certificate and in a press release:*
Please provide your first name/nickname as you would like it to appear on a name badge:*
Email*
Enter Email Confirm Email
Phone*

PDK will send out press releases to up to three of your local media outlets. Please fill out the information below.

Name of Media Outlet	Name of Education Reporter, Editor or Blogger at Media Outlet (if you have it)	Email Address for Reporter, Editor of Blogger at Media Outlet (if you have it)	Phone Number for Media Contact (if you have it)

To add additional media outlets, click the "plus" next to the first row.

If you wish, PDK will send out a letter recognizing you as a new Emerging Leader to your supervisor. If you would like us to send this letter, please include the information below.
Supervisor's Name (include title) and Position How We Should Address this person Supervisor's Email address Supervisor's Mailing address
One definition of leadership is “taking responsibility for something that you feel is critically important.” Please share what you have decided to take responsibility for in the field of K-12 education. (100-200 words)*
How have you worked to advance this area that you have claimed responsibility for? (100-200 words)*
What do you plan to do in the near future to help advance this issue, topic, trend, or policy? (100-200 words)*
A person can make a difference in a number of ways. They can influence federal, state or local policy, they can influence school culture and climate, they can influence their professional network of peers and colleagues, they can influence students, they can influence pre-service teachers, they can influence education research, they can influence public opinion about an issue, and so forth. Please highlight at least two ways in which you are an influencer. (100-200 words)*
What is something that you are proud of in your education work to date? (100-200 words)*
What do you wish the general public knew about your particular specialty area in education that the general public does not know? (100-200 words)*
Please upload a a high-resolution head shot photo (file size of 1MB or more).

Emerging Leaders Request for Information

Prospective Members

Current Members

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