2010 KIMMEL LEADERSHIP AWARD
KIMMELLEADERSHIPCENTER
NOMINATION FORM
NOMINATIONS MUST BE TYPED - All sections of the nomination form must be completed accurately and legibly with verifiable information. Incomplete, illegible nominations will not be considered. Student Government reserves the right to make no award if in its judgment no nomination warrants such recognition.
Organizations Name: Click here to enter text.Program Name: Click here to enter text.
Program Date:Click here to enter text. / Program Location:
Was the program funded by Student Government? Choose an item.
(Funding by Student Government is not required for this award.)
Program Attendance
StudentAttendance:Click here to enter text. / Faculty/Staff Attendance:Click here to enter text.Public Attendance:Click here to enter text.
Person Completing the Form
Name: Click here to enter text.Title: Click here to enter text. / Phone: Click here to enter text.
Street Address: Click here to enter text. / City: Click here to enter text.
State: Click here to enter text. / Zip Code: Click here to enter text.
Email: Click here to enter text.
I certify that the information submitted is accurate and verifiable.
Signature______
- Describe the educational value of your program. What was the intention of the educational value of the program? How did this information affect the campus? How did the program shed new light on the topic?
Click here to enter text.
2.Describe how the educational program was promoted to the campus or encouraged community participation. Attach copies of posters, fliers, and/or Alestle ads to support your nomination.
Click here to enter text.
3. Describe how the educational program addressed the following areas: diversity, educational value, and attendance.
Click here to enter text.
Return the completed application and any supporting materials by 4 p.m. onFriday,
April 5, 2013to:
Student Government
SIUEKimmelLeadershipCenter
Campus Box 1160
Edwardsville, IL62026-1160