Student of the Month Nomination Form

Please complete the following fields to nominate a student for this award.

Upon submission, the form will be sent to Daniel Gutierrez, lecturer in Administration of Justice, and Lorie Kramer, assistant teaching professor of Rehabilitation and Human Services and RHS program coordinator.

The Faculty-Student Relations Committee will vote to decide the winner.

First name of student nominee: *

Last name of student nominee: *

General category for nomination (Check all that apply) *

Civility

Academic Improvement

Community Care and Involvement

Personal Achievement Over Obstacles

Other (please specify):

Reason for nomination (Please be specific): *

First name of nominator (optional):

While this information is optional, please complete this section in case the committee has questions about the nominee.

Last name of nominator:

Nominator's email:

Nominator's cell phone number:

Date submitted: *

Note: The date should reflect a date prior to or the last date of the month in which the student is being nominated for the award.

Month

Day

Year

Math question * 12 + 4 =

Solve this simple math problem and enter the result. E.g. for 1+3, enter 4.

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Student of the Month Nomination Form

Student of the Month Award Recipients

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Student of the Month Nomination Form

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