Fillable Presidents Citation Fill 2018

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Presidents Citation Fill 2018

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We are now accepting nominations for the President’s Citation which is presented annually
to outstanding seniors selected by the President of the University. e award recognizes
accomplishments and contributions that benet the University. Particular consideration is given
for leadership and service roles as volunteers. is special award recognizes achievement and
contributions during the period while students were in attendance at Central Connecticut State
University. In this context, the Screening Committee will review nominations and supporting
materials using the following criteria.
1. Leadership as exemplied through successful fulllment of leadership responsibilities
in student organizations or other campus roles
2. Signicant volunteer contributions to other students and/or the larger University community
3. Academic success
4. Must be a graduate of the current academic year (December 2017 through August 2018)
Nominations should include the ID number of the nominee and complete information regarding
oces held, community service, and any special awards or recognition. is involvement may be
on or o campus achievements but must have occurred while the nominee was a CCSU student.
Please note your nominated student may complete the application form.
Nominating faculty, please send the award nomination with letter of reference to the
President’s Oce by Friday, March 2, 2018. Any questions can be directed to Katherine Poirier,
Chairperson, at (860) 832-1982 or email at Poirier@ccsu.edu.
Note: One letter of reference from an academic or administrative faculty member is required for
nomination.
President’s Citation recipients will be recognized at a special ceremony to be held on Tuesday,
April 24th, 2018 at 4:00pm in Founders Hall. Individuals selected for this distinction will be
contacted prior to the ceremony.
Central Connecticut State University
President’s Citation
2018 Award Nomination
Student’s Name: _________________________________ Student’s ID#: __________________
Student’s Signature: ____________________________________________________________
Nominator’s Name: ____________________________________________________________
Nominator’s Signature: _________________________________________________________
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Page 1
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BIOGRAPHICAL INFORMATION
Full name:
Campus Address:
Permanent Address:
Campus phone:
E-mail address:
Major:
Anticipated graduation date:
Anticipated degree (circle one): BA
Date of birth: ___/___ /___
Spouse’s name:
Children’s names and ages:
Father’s (or guardian’s) name:
Father’s address:
Mother’s (or guardian’s) name:
Mother’s address (if dierent from above):
EDUCATION
College/ High school Degree/ Date earned Major
HONORS/AWARDS EARNED
Please list all honors, awards, honor society memberships and special scholarships.
Recognition Year earned
Permanent phone:
Cell phone:
Minor: GPA:
BS Other:
Birthplace:
Page 2
* To be completed by nominated Student
CAMPUS ACTIVITIES/OFFICES HELD
Please include the full name of any organization, your full title and the year in which you
participated in the activity or held a particular oce.
Activity/Organization Title Year(s)
ON-CAMPUS WORK EXPERIENCE/INTERNSHIPS
Please list any work experience aliated with any campus oce.
Title Dates Employer Responsibilities
COMMUNITY ACTIVITIES/PUBLIC SERVICE
Include the name of the organization, any title held and/or responsibilities, and the dates you
participated in the activity.
Organization Title/Responsibilities Dates
Page 3
ADDITIONAL INFORMATION
Please feel free to include any other academic and service achievements, such as travel abroad,
graduate school plans, papers presented at conferences, future plans, etc.
Page 4
AM 12/26/2017
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Completed 8 March 2020

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