2019-2020 OUTSTANDING STUDENT AWARD NOMINEE
REGIONAL CAMPUS FORM
Outstanding Academic Achievement (choose one)
(Double click on box to select “checked”)
Associate of Arts (AA)
Associate of Science (AS)
Associate of Applied Science (AAS)
Certificate
Outstanding Service to Campus
Special Program:
(Please TYPE or PRINT all information on this form)
Program Area:
Student Name:
Student ID Number:
Physical Address:
City/State/Zip:
Phone Number:
Email Address:
Plans to Transfer to (University):
G.P.A.:
STATEMENT ON NOMINEE
Please note any special contributions, voluntary tutoring or other assistance to faculty,
staff or students, and extra-curricular activities the student has made to the college and/or
the community. Your statement should focus on academic and extra-curricular
achievements and stay away from personal and family references. This will help the
Awards Committee consider this nominee for additional awards.
Faculty (TYPE or PRINT name) Phone Ext. Date
Campus Supervisor Signature Phone Ext. Date
Print Supervisor Name Regional Campus
This nomination is due in your AVP or VP’s office by February 13, 2020
click to sign
signature
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