Student Leadership and Activities

Please fill out the fields below with information about your award for Leadership Recognition Night, scheduled on Tuesday, May 14 at 5:30 pm. in the WUC Pacific Room.

Nominations will be due Monday, April 8 at 5:00pm

If you have any questions contact Megan Habermann at 503-838-8659 or habermam@wou.edu OR Angie Barry at 503-838-8064 or barrya@wou.edu

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: