About You

Your Name:
First: Middle Initial: Last: Suffix: Sr.Jr.IIIIVV

Your Phone:

Your E-mail:

About the Nominee

Organization Name:

Organization President:
First: Middle Initial: Last: Suffix: Sr.Jr.IIIIVV

Phone: E-mail:

Hometown: Local Newspaper:

About the Event

Event Name:

Event Date:

Event Location:

Is this an annual event?    Yes     No

How many students attended?

How was the event advertised?
Please provide documentation to the Office of Campus Activities, 001 Creese Student Center
(As there is no spell check on this form, it may be helpful to compose your response using Word
or other word processing application, then paste your response in this space)

Why does your organization deserve this award for this community service event?
(As there is no spell check on this form, it may be helpful to compose your response using Word
or other word processing application, then paste your response in this space)

Other comments/Notes: