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LRN 2009

2013-2014 Award Designation Form

Please fill out the fields below with information about your award for Leadership Recognition Night, scheduled on Tuesday, May 13 at 5:30 pm. in the WUC Pacific Room.


Nominations will be due Monday, April 7 at 5:00pm


If you have any questions contact Megan Habermann at 503-838-8659 or OR Angie Barry at 503-838-8064 or


Title of Award:


Award Winner Information

First Name:

Last Name:

Student V# (Required)


Presenter Information

Presenter Phone Number:

Presenter Name:


Nominator Information

Name of Person Making Nomination (First and Last) :

Phone Number of Person Making Nomination:

Person Making Nomination E-mail (required):



Would you like Student Leadership & Activities office to produce a certificate for your award presentation? Yes No

Student Name as it will appear on certificate (if requested):

Will the student be aware that s/he is receiving the award prior to the dinner? Yes  No

Are there any specific time requests as to when the award should be given during the dinner program? (early, late, middle, before 7 p.m., etc.)  Yes  No

If "Yes", please elaborate

Please state how the award winner was determined (i.e. faculty recommendation, staff selection, peer selection, combination or other?)

Please insert any other details or comments here:


This submission form is submitted via e-mail. You will be asked to confirm your e-mail after clicking this submit button; you must do so to fully submit your information. You will NOT receive an e-mail notifying of your submission once complete.

If you do not have access to the student's V# call Angie Barry at 503-838-8064



Student Leadership and Activities 503-838-8261 | or e-mail: