DISTRICT 48
WHERE LEADERS ARE MADE
TOASTMASTERS DISTRICT 48
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Passport Program Form
Name
*
First
Last
Email
*
Date
*
MM slash DD slash YYYY
Club Name
*
Education:
Complete any 2 Levels in Pathways (between 7/1/2020 and 4/30/2021)
Attend one of the upcoming TLI Sessions
Dynamic Leadership:
Select pathways level achieved.
Select
DL1
DL2
DL3
DL4
DL5
Date Completed
*
MM slash DD slash YYYY
Effective Coaching:
Select pathways level achieved.
Select
EC1
EC2
EC3
EC4
EC5
Date Completed
*
MM slash DD slash YYYY
Engaging Humor:
Select pathways level achieved.
Select
EH1
EH2
EH3
EH4
EH5
Date Completed
*
MM slash DD slash YYYY
Innovative Planning:
Select pathways level achieved.
Select
IP1
IP2
IP3
IP4
IP5
Date Completed
*
MM slash DD slash YYYY
Leadership Development:
Select pathways level achieved.
Select
LD1
LD2
LD3
LD4
LD5
Date Completed
*
MM slash DD slash YYYY
Motivational Strategies:
Select pathways level achieved.
Select
MS1
MS2
MS3
MS4
MS5
Date Completed
*
MM slash DD slash YYYY
Persuasive Influence:
Select pathways level achieved.
Select
PI1
PI2
PI3
PI4
PI5
Presentation Mastery:
Select pathways level achieved.
Select
PM1
PM2
PM3
PM4
PM5
Date Completed
*
MM slash DD slash YYYY
Strategic Relationships:
Select pathways level achieved.
Select
SR1
SR2
SR3
SR4
SR5
Date Completed
*
MM slash DD slash YYYY
Team Collaborations:
Select pathways level achieved.
Select
TC1
TC2
TC3
TC4
TC5
Date Completed
*
MM slash DD slash YYYY
Visionary Communication:
Select pathways level achieved.
Select
VC1
VC2
VC3
VC4
VC5
Date Completed
*
MM slash DD slash YYYY
Date of TLI Session Attended
*
TLI DATES: • January 16, 2021 • January 30, 2020
MM slash DD slash YYYY
Travel the District:
Visit another club and submit in the Ambassador Program (a virtual visit is okay until Toastmasters International changes the rules).
Name of Club Visited
*
Date Club was Visited
*
MM slash DD slash YYYY
Volunteer & Grow:
Serve as a functionary in a Club or Area Contest for District 48 (between 7/1/2020 and 4/30/2021)
Serve as a functionary in an Area or Division Contest for District 48 (between 7/1/2020 and 4/30/2021)
Club Name or Area # for Contest
*
Contest Role
*
Contest Chair
Contest Master
Chief Judge
Judge
Ballot Counter
Timer
Sergeant at Arms
Area # or Division Letter for Contest
*
Contest Role
*
Contest Chair
Contest Master
Chief Judge
Judge
Ballot Counter
Timer
Sergeant at Arms
Earn Some Bling:
Achieve Full Circle.
Date that FULL Circle was Achieved
*
MM slash DD slash YYYY
Mentorship:
Mentor a new Toastmaster member (work with your club officers to be assigned a new member to mentor).
Name of New Member Mentored
*
Club Name of New Member Mentored
*
Share the Love:
Recruit 2 New Members. Share the love of Toastmasters by inviting your family, friends, or perfect strangers to invest in their personal growth.
Names of New Members Recruited
*
Club Names of New Members Recruited
*
Serve as Club Officer:
(If you are not able to complete any one of goals 1 – 6 then serve as a club officer for 6 months and use goal 7 as a replacement)
Served as Club Officer for 6 months.
Club Officer Role
*
President
VP Education
VP Membership
VP Public Relations
Secretary
Treasurer
Sergeant at Arms
Use Goal 7 to Fulfill:
Goal 1
Goal 2
Goal 3
Goal 4
Goal 5
Goal 6
Phone
This field is for validation purposes and should be left unchanged.
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