Serial No: ______

(For Official Use Only)

CCAAward Nomination Form (INDIVIDUAL)

CCA Merit Award: Arts [ ] Sports [ ] Leadership [ ]

Higher Individual Award: CCA Gold [ ] Artiste of the Year[ ] Sportsperson of the Year [ ] Student Leader of the Year [ ] (You can tick more than one category)

Please attach the candidate’s SEAL transcripttogether with this form.

FOR SELECTION COMMITTEE ONLY:
SUCCESSFUL NOMINATION(Please tick relevant options)
[ ] CCA Merit Award (Arts, Sports, Leadership)
[ ]Artiste of the Year, Student Leader of the Year, Sportsperson of the Year
[ ]CCA Gold
or
UNSUCCESSFUL FOR THE FOLLOWING REASON(S) (Please tick and sign)
[ ] Did not meet the eligibility criteria, please state:______
[ ] Did not pass all subjects, please state:______
[ ] Incomplete nomination form, please state:______
Endorsed by CCA Award Coordinator: Date:
______
Important information:
  1. Please read the eligibility criteria before completing the form.
  2. The selection of candidates will be left to the Selection Committee, and the decision of the Committee isfinal. Neither direct communication nor appeals will be entertained.
  3. The Organising Committee reserves the right to revise and amend any of the terms and conditions.
  4. The Organising Committee reserves the right not to award any of the awards if no suitable candidate is identified.
  5. Please return the completed form to the Student &Alumni Affairs Department by 6.00pm, 27March2015 (Friday).

1 MEMBERSHIP OFSTUDENT GROUP
Name of Student Group:______
2PERSONAL PARTICULARS
Name as in NRIC (CAPITAL): ______
Admin No: ______NRIC No: ______Hp No: ______
Email: ______
Year of Study in AY2014/2015 (Please tick only one)
1 [ ] 2 [ ] 3 [ ]
School (Please tick only one)
ASC [ ] BUS [ ] DES [ ] ENG [ ] IIT [ ] HSS[ ] Diploma: ______
Did you pass all subjects in AY2014/2015?
Yes [ ] No [ ]
Please state subject(s) failed: ______
3DECLARATION BY STAFF IN CHARGE
l declare, to the best of my knowledge, that the nominated student has fulfilled all the criteria as stated and that l have not suppressed any relevant information. I support this nomination.
Name of Staff:______Signature & Date: ______

4 Write-Up by Staff I/C for HigherAward and CCA Gold nominations only

Please be as specific as possible about student’s achievements, and the significance of the achievements. Your write-up carries considerable weight in the selection process.

This portion should preferably be typewritten to assist in processing.

5 For all nominees: Please AttachSEAL Transcript

Highlightor underlinesignificant events (AY 2014/2015) in the SEAL transcript

For CCA Gold Award, highlight/underline:

  1. Excellent SEAL grade
  2. CCA Merit Award 2014
  3. Organiser role / Student leader of significant high profile projects (more than 2 events/projects) AND/OR
  4. Competition / events (with at least 5 participating institutions)in which student represented TP.

For CCA Merit Award (Sports) and/or Sportsperson of the Year, highlight/ underline:

  1. Excellent SEAL grade
  2. Competition / events (with at least 5 participating institutions)in which student represented TP.

3.Silver and/or better medal finishing in an inter-tertiarycompetition (e.g. POL-ITE) for the year. AND/OR

4.Bronze medal for IVP, National Level equivalent.

For CCA Merit Award (Arts) and/or Artiste of the Year, highlight / underline:

  1. Excellent SEAL grade
  2. High-profile external events in which student represented TP. AND/OR

For CCA Merit Award (Leadership) and/orStudent Leader of the Year, highlight / underline:

  1. Excellent SEAL grade
  2. Organiser / Coordinator /Student leaderof significant high profile projects (at least 2 events/projects)

1