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

Brock University Alumni Association Student Award Nomination Form

Brock University recognizes the important role it plays in nurturing and fostering engaged citizens who make a meaningful contribution within and beyond their immediate community. The Brock University Alumni Association Student Award recognizes Brock students who contribute to a vibrant on-campus life and constitute an invaluable resource in the broader community - locally and nationally.

Record your and the nominee's information in the spaces below. In order for an application to be considered, all components of the application must be received by May 1, 2012.

Brock University Alumni Association Student Award Nomination Form

To be eligible for this award, the student must meet the following criteria

a) Student Status: must be a part-time or full-time Brock student; completed a minimum of ten credits at Brock University

b) Extra-curricular Involvement: demonstrated a meaningful contribution towards the enrichment of extracurricular life both on-campus and in the broader community; locally, regionally or nationally

c) Academic Requirements: achieved an average of B in his/her major

Nominator's Information

Name: *

Address : *

Postal Code: *

Phone Number: *

Brock ID #:

Brock affiliation: *

Nominee's Information

Applicant's Name: *

Student ID: *

Major: *

Year of Study: *

Phone Number: *

Rate the nominee by comparison to his/her peers.

Among his/her peers, how does the nominee rank in terms of the following criteria?

Leadership capabilities: *

Extra-curricular involvement at Brock : *

Community involvement and volunteerism: *

Academic achievement: *

Integrity : *

Describe the nominee's extra-curricular activities:

Please be specific and provide details of three extra curricular activities in which the nominee has participated.

First Example

Type of Involvement: *

(Student club/org., University Committees, Athletic group, Not for Profit org, Faith group)

Key Contributions : *

Duration : *

( Number of hours/week, term or month, or Number of month or years)

Type of Participation : *

Second Example

Type of Involvement : *

(eg. Student club/org. University Committees, Athletic group, Not for Profit org., Faith group)

Key Contributions : *

Duration : *

(Number of hour/week, term or month or Number of month or years)

Type of Participation: *

Third Example

Type of Involvement : *

(eg. Student club/org. University Committees, Athletic group, Not for Profit org., Faith group,)

Key Contributions : *

Duration : *

(Number of hour/week, term or month or number of month or years)

Type of Participation: *

State why you believe the nominee should receive this award.

Please respond here: *

Please limit your statement to a maximum of 500 words.

State the nature and duration of your relatationship with the nominee.

Please respond here: *

Nominations must be submitted by May 1, 2012

In order for your nomination to be considered, all components of the nomination must be received by the BUAA by May 1, 2012.

Thank you

Thank you for applying for the Alumni Association Alumni Student 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/alumnistudentawards/BUAA-student-award-nom-form