Servant Leadership Award - Student Nomination Form

Name of Nominee:

Organization Affiliation of Nominee:

Semester of Graduation of Nominee:

Name of Nominator:

Phone Number:

Email:

Local Address:

Selection Criteria:

1. Commitment to others
2. Value and impact of service
3. Fostering spirit of service

Please use the space below to form a detailed explanation of how your nominee has demonstrated commitment to others and service activities in 250 words or less.

Please submit and return all award materials no later than 11:59 pm on Monday, April 2, 2012.