Request a Major Exemplification

Requests and kit orders Resource

Exemplification Request

Fill out this form and submit to the State Deputy for approval

Date of Exemplification*
Enter the Date you would like to have your Degree. Please give as much notice as possible
MM slash DD slash YYYY
District Number*
District Deputy*
Phone number*
Email address*
Location of Degree*
Enter the name of the Church or Hall, and the city (St Peter's, North St Paul for example)
Postal address*
This is needed to provide Google Map directions
Additional information (if needed)
Entry at rear of Church, for example
Will there be an Admission Degree?*
Admission Degree Start Time*

: Hours

Minutes
Staff*
Enter the name of your Admission degree staff
Will there be a Formation Degree?*
Formation Degree Start Time*
60 minutes after start of Admission Degree

: Hours

Minutes
Formation Degree Staff Requested*
Enter the name of your preferred staff, or YES to have one assigned
Will there be a Knighthood Degree?*
Knighthood Degree Start Time*
60-90 minutes after start of Formation Degree

: Hours

Minutes
Knighthood Degree Staff Requested*
Enter the name of your preferred staff, or YES to have one assigned
(Separation time between degrees may be reduced to 60 minutes if 2 rooms are used for degrees)
Host DD responsibilities:
Advertising the degree
Providing Admission degree team (if scheduled) and degree kits
Ordering sufficient Knighthood degree Medallions for the expected Candidate count
Verifying with CO and Formation degree staff Captain at least 1 week prior to the scheduled date
Formation degree staff travel expenses – have a check available prior to the start of the degree (check with SCC for rules)

ALL REQUESTS MUST BE APPROVED BY THE STATE DEPUTY AND ONCE APPROVED CAN ONLY BE CANCELLED BY HIM
I have read and agree to comply with these requirements*
(DD must enter Name here)
When this form is complete, click Submit for State Deputy to add his approval below.
State Deputy Approval
Date
MM slash DD slash YYYY

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Request a Major Exemplification

Exemplification Request

Host DD responsibilities:

ALL REQUESTS MUST BE APPROVED BY THE STATE DEPUTY AND ONCE APPROVED CAN ONLY BE CANCELLED BY HIM

When this form is complete, click Submit for State Deputy to add his approval below.