CPCU Claims Section

Circle of Excellence (COE) Submission Form

“Get the Recognition You Deserve!”

Activity Time Frame: Anytime between July 1, 2006 through May 31, 2007

Final Submission Due Date: May 31, 2007

Two ways to submit:

1. email form to BLEVINE@ECNIME.COM, OR EJSIEBERCO@AOL.COM, OR RROSE@HASTINGSMUTUAL.COM

2. fax form to barbara levine at 561-392-5881

2. Fill out the web form located here

**Information need not be limited to space provided

NOTE: COE Submissions may be used for both local chapter and Claims Section

please send submissions throughout the year as you perform the activity!!

Qualifying Activities (Suggestions):

Ø Conduct, Create, or Participate in workshop, symposium, Forum or other educational event; for employer, chapter, or non industry related event

Ø Publish articles in either CPCU or Non CPCU newsletters, magazines, websites

Ø CPCU Annual Meetings: Conduct Seminars, Staff Sections or New Designee Booth

Ø Serve as officer for Local Chapter or Conduct CPCU Chapter Meeting

Ø Teach CPCU or IIA class

Ø Participate or create an Outreach programs for National or Chapter Membership

Ø Participate in I Day; via speaking opportunity, participation on forum/panel, or assist in staffing I day booth

Ø Sponsor a new designee program or event

Ø Create or participate in Ethics Awareness Events

Ø Engage in community service projects done in conjunction with other industry or non industry groups

Please be creative!!!

We encourage submission of any activity which increases the “visibility” of the CPCU designation, provides professional education opportunities, involves community outreach, or promotes ethical behavior within the industry

COE Circle of Excellence Submission Form

Submission Information:

Two ways to submit:

1. email form to BLEVINE@ECNIME.COM, OR EJSIEBERCO@AOL.COM, OR RROSE@HASTINGSMUTUAL.COM

2. fax form to barbara levine at 561-392-5881

Name of section Member:

name of event:

date of event: ___/___/_____

description of event:

(if additional information is necessary, please continue at bottom of form)

location of event:

************if educational program presented, please attach handouts

number of hours (duration of event):

number of hours in preparation:

Event Sponsor(s)