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Request for Outside Leading with Values Seminar Credit

This form should be used if your chapter is seeking Leading with Values credit from your Regional Member Experience Specialist (MES) for seminars, lectures or other events held on your campus or in your community outside of Leading with Values seminars. Once you submit this form, the information you provided will be shared with your MES. Requests for credit should be submitted no less than one month prior to the end of the academic term during which the program took place. 

A note about seeking Leading with Values credit outside of Leading with Values seminars:

The Pi Beta Phi Values Refresher as well as one Leading with Values seminar should be completed during the calendar year prior to seeking outside credit. If this is NOT completed, credit for the outside seminar will not be offered. Requests for credit should also be submitted within 30 days of the seminar. You may only count 1 outside seminar for credit toward the Chapter Evaluation.

The MES reserves the final say as to whether or not credit will be given for this activity. 
Please note that Critical Conversations Speaker Series visits will not count for outside credit as Leading with Values Seminars; however, they do meet other criteria on the Chapter Evaluation.

Please fill in the following information as thoroughly as possible in order for your MES to make a most informed decision. 

Name: 

Email address: 

Vice President Member Experience's email address: 

Chapter (please enter in format of "AL Alpha"): 

Program name: 

Date program was presented:   [None] Select a Date Delete the Date

Which core value and learning outcome did the program focus on? See a list of Pi Beta Phi core values and learning outcomes here.

Who sponsored the program?: 

Percentage of chapter members in attendance: 

Please provide a brief description of the campus/community seminar/speaker:

What did participants learn?

What type of chapter discussion accompanied the program?

How was the information shared with the entire membership?