Published on Brock University (http://brocku.ca)

Brock University Alumni Association Badger Award Nomination Form

The Badger Award was established in memory of Victoria Catherine Hull. The award honors graduating students who have demonstrated outstanding leadership qualities by their involvement in the extra-curricular life of the university, while at the same time having maintained an above-average academic standing.

Please record your and the nominee’s information in the spaces below.

Brock University Alumni Association Badger Award Nomination Form

To be eligible for this award, the student must fulfill the following requirements:

a) Student Status: be registered as a full-time or part-time student at Brock; be eligible for graduation at the completion of the current academic session and graduate at the appropriate convocation. Should a person selected not graduate, the award would revert to the next eligible candidate.

b) Extra-curricular Involvement: demonstrated outstanding leadership qualities through contribution to the extra-curricular life of the Brock community.

c) Academic Requirements: have achieved an overall average of 75% or better.

Nominator

Name: *

Address: *

Postal Code: *

Area Code and Phone Number: *

Brock ID #: *

Please Check: *

Faculty

Staff

Graduate

Student

Applicant

Applicant's Name: *

Student ID: *

Applicant's Email Address: *

Major: *

Year of Study: *

Applicant's Phone Number: *

Please provide a description of the nominee’s extracurricular activities.

Please be specific and provide details.

First Example

Type of Involvement (eg. Student club/org. University Committees, Athletics, etc) : *

Leadership Role : *

Key Contributions : *

Duration (# of hour/wk, term or month or # of month or years) : *

Second Example

Type of Involvement (eg. Student club/org. University Committees, Athletics, etc) : *

Type of Participation- please check one : *

Volunteer

Paid

For Academic Credit

Leadership Role : *

Key Contributions : *

Duration (# of hour/wk, term or month or # of month or years): *

Third Example

Type of Involvement (eg. Student club/org. University Committees, Athletics, etc) : *

Leadership Role: *

Key Contributions : *

Duration (# of hour/wk, term or month or # of month or years) : *

Fourth Example

Type of Involvement (eg. Student club/org. University Committees, Athletics, etc) : *

Leadership Role : *

Key Contributions : *

Duration (# of hour/wk, term or month or # of month or years) : *

I've known the nominee for __ years. Please state how many years and the capacity of your relationship.: *

To approximately how many students in the past five years and at the same level of study are you comparing the applicant? : *

Please provide a statement of why you believe the nominee is worthy of this award. Please limit your statement to a maximum of 500 words.: *

Please return this assessment by May 1, 2012

Thank You

Thank you for applying for the Alumni Association Badger Award. You may be contacted by the Alumni Association if any further information is required for your application. Best of Luck!

Source URL: http://brocku.ca/alumni-association/recognition/student-awards/badgerawardnomform%20