William N. Wasson Student Leadership
& Academic Awards Nomination Form

Nomination Form

First Name of nominee

Last Name of nominee

Name of institution

Declared degree

Major

Email

Student status

Current Full-time: Yes
or
December 2010 Graduate:Yes
or
Spring 2011 Graduate with less than full-time status:Yes

Overall grade point average

on a scale.

Undergraduate students must have a minimum of 2.75 on a 4.0, or 3.75 on a 5.0 scale. Graduate students must have a 3.0 on a 4.0 scale, or a 4.0 on a 5.0 scale.

By submitting this nomination you are verifying that the reported GPA is accurate.

Indicate nominee status

Undergraduate      Graduate

Name of NIRSA Professional Member supporting nomination

Position title

Full-time employee

Yes       No

Only one nomination per nominee is allowed. If you like, you can provide the names of other professionals supporting this nomination.

Name of institution

State/province/other

<Select> Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming Guam Puerto Rico Armed Forces Americas (AA) Armed Forces Outside Americas (AE) Armed Forces Pacific (AP) New Brunswick Newfoundland Alberta Northwest Territories Nova Scotia Prince Edward Island Quebec Saskatchewan Ontario Yukon Territory Manitoba British Columbia None

Region

<Select> Region I Region II Region III Region IV Region V Region VI

Nominator mailing address

Nominator phone

Nominator email

1. Please list the nominee’s scholarship or professional development demonstrated through research, honors, self-improvement, continuing education, certifications, presentations, participation in professional organizations (e.g., internships, NIRSA memberships, published articles).
(750 character max. Please make your list using bullet points)

2. Please list the nominee’s leadership within the recreation department, including but not limited to: service through participation in student organizations, advisory board or committee work, community/campus activity related to recreation, leadership in employee training or orientation programs, or other leadership opportunities.
(750 character max. Please make your list using bullet points)

3. Please list the nominee’s campus or community involvement through volunteerism outside of their scope of responsibilities within their recreation program.
(750 character max. Please make your list using bullet points)

4. Nominees must have taken an active role in promoting recreational services/activities across their campus community with the goal of including, recruiting, and/or retaining a diverse student population into these events. Please include specific examples of the nominee’s role in activities/events and their level of participation that help meet this goal.
(1000 character max. Please make your list using bullet points)

Please do not include resumes or transcripts.

Please note that upon notification of selection, a photograph will be requested for display at the NIRSA Annual Conference & Recreational Sports Exposition.

Letter of Support
(The letter of support should provide the review committee additional information that supports the application)
(Not to exceed 400 words)

If this nominee is awarded a William N. Wasson Student Leadership & Academic Award:

How should the nominee's name appear on the award?

How should the institution's name appear on the award?

** All nominees should be prepared to submit a color 4x6 portrait-orientation photo of themselves to: NIRSA National Center at least three weeks in advance of the Annual Conference for display in the NIRSA booth at the Recreational Sports Exposition. Photos cannot be returned.

** Duplicate awards can be purchased for display in your facility. Please contact the NIRSA National Center for pricing information. Duplicate awards should be ordered at the time the Committee Chair announces awardees and will be mailed to the nominator after the conference.

 NOTE: After submitting your proposal, you will receive an email confirmation from the NNC within 3 business days. If confirmation is not received, please contact membership@nirsa.org.