Chancellor’s Award for Student Excellence Nomination Form


The Chancellor's Award for Student Excellence acknowledges students who have demonstrated student excellence in a variety of areas. We are seeking nominations from the campus community of students who have best demonstrated, and been recognized for, the integration of academic excellence with other aspects of their lives, which may include leadership, campus involvement, community service, arts, athletics and/or career achievement.

Only students graduating between June 2016 and May 2017 will be considered. All information must be typed on the form; handwritten copies will not be accepted. Only awards received while at current institution are applicable. (Awards from another college or high school should not be included.)

Nomination Packets must be submitted by Friday, January 6, 2017 at 4:00pm and include the following:

·  Completed Nomination Form

·  2-3 Letters of Recommendation

·  Resume – not to exceed 2 pages (optional)

Packets can be submitted electronically via email as a pdf file to or in-person to the Office of Community Development, College Union 203.


Nominee Name: Click here to enter text.

Month/Year Started College: Click here to enter text. Graduation Month/Year: Click here to enter text.

Degree: Click here to enter text. Major: Click here to enter text.

GPA: Click here to enter text. Email Address: Click here to enter text.

Address (if selected, letter will be sent to this address): Click here to enter text.

City: Click here to enter text. State: Click here to enter text. Zip: Click here to enter text.

Hometown (city, state): Click here to enter text.

This student is being nominated by:

☐ Self ☐ College Department or Office (please specify): Click here to enter text.

*Note: If being nominated by college department, it is highly recommended that student assists with the nomination packet to ensure all areas of accomplishment are included.

Please share a brief student biography (75 words or fewer). Please write in the third person and be sure to proofread, as this bio will be used in the official event program if selected:

Click here to enter text.

For examples of student biographies, click here to see last year’s program booklet.

List the student’s top three accomplishments. (50 words or fewer each)

1.  Click here to enter text.

2.  Click here to enter text.

3.  Click here to enter text.

Areas of Accomplishment

For each category, list any awards, recognition or accomplishments that demonstrate excellence in the area of academic excellence. You may enter as many items as you wish in each category. It is not necessary to fill each category. Include dates and a brief description.

ACADEMIC EXCELLENCE

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LEADERSHIP

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CAMPUS INVOLVEMENT

·  Click here to enter text.

COMMUNITY SERVICE

·  Click here to enter text.

ARTS (VISUAL, PERFORMING AND WRITTEN)

·  Click here to enter text.

ATHLETICS

·  Click here to enter text.

CAREER ACHIEVEMENT

·  Click here to enter text.

OTHER (please specify)

·  Click here to enter text.

Letters of Recommendation

Please indicate the name and title of any individuals writing a letter of recommendation.

1.  Click here to enter text.

2.  Click here to enter text.

3.  Click here to enter text.

Resume (optional)

Please indicate if a resume, not to exceed 2 pages, will be included in the nomination packet.

Choose an item.

Any questions can be directed to Kim Piatt, Assistant Director of Community Development at or 595.395.2987