Nomination Form: Student Civic Leadership Awards

Student Name(Required)

First Last

Student's Email(Required)

College(Required)

Major

Expected Graduation Date

Student's Mailing Address

Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country

Nominator's Name(Required)

First Last

Nominator's Email(Required)

What qualities does the student possess that are indicative of an effective civic leader? (250 words or less)(Required)

What actions has the student taken to address community/campus needs, and how has the community/campus benefitted? (250 words or less)(Required)

How has the student’s civic engagement work impacted their academic achievement and career aspirations? (250 words or less)

Please provide a short summary (150 words) of the student’s civic leadership.

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