Student Leadership Award

Nomination Form

The University of Illinois Alumni Association has the privilege of honoring exceptional graduating students for their volunteer contributions as leaders of student societies, groups and organizations at UIS. The UIS Campus Alumni Advisory Board (CAAB) sponsors this recognition program and would appreciate your assistance in identifying deserving individuals on the campus.

Nominees are undergraduate, graduate or professional students who have received their degrees in summer or fall 2011 or candidates for graduation in May 2012. Nominees should have demonstrated exceptional leadership through their involvement in campus and/or student organizations. Leadership might be exemplified through an officer or chairman position or outstanding loyalty and commitment by a person whose actions inspire others. The leadership that is being recognized could have spanned an entire academic career or could be more limited in scope.

Recipients will be honored by the Alumni Association at a program near graduation.

Deadline for nominations: Wednesday, Feb. 15, 2012

For more information:
Chuck Schrage
Vice President of Alumni Relations
chuckschrage@uillinois.edu
217/206-7395

ALL INFORMATION MUST BE COMPLETED. Please use a separate form for each student nominee.

INFORMATION ABOUT THE NOMINEE:

Full name:

Address:

City:

State:

Zip code:

Phone:

E-mail:

College GPA (if known)

Please describe the nominee’s involvement, service and leadership in societies, groups and organizations at UIS. In your opinion, why does the nominee deserve this award?
Please submit any additional materials that would enhance the quality of the nominee’s endorsement.

Leadership Activities

Campus Organization	Position held	Dates	Reference name/phone


Campus Organization	Position held	Dates	Reference name/phone


Campus Organization	Position held	Dates	Reference name/phone


Campus Organization	Position held	Dates	Reference name/phone