David S. Betzner Award Nomination Form

David S. Betzner Award Nomination Form






The David S. Betzner Award recognizes alumni who have demonstrated loyalty and commitment to their alma mater by supporting Brock University and/or the Alumni Association through continuous dedicated volunteer service. Named in honor of David Betzner (BSc '85) who lent his time and energy to the Brock University Alumni Association for 18 years, including a term as president. David played a significant role in developing the constitution and governance model for the Alumni Association and has served as an advisor and mentor to numerous presidents.

To nominate an individual for the David Betzner Award, record your and the nominee's information in the spaces below.

David S. Betzner Award Nomination Form

Nominator
(xxx) xxx-xxxx
Nominee
(xxx) xxx-xxxx
Check each item at the point on the scale that best indicates your rating of the nominee as compared to his/her peers
Support Statement

The nominator is asked to attach a completed statement of support using the following questions as a guideline.
(Maximum of 2 typed pages in length)

Pay particular attention to the focus of the award: supporting Brock University and/or the Alumni Association through continuous dedicated volunteer service.

1. How has the nominee’s volunteer service made a difference to the University? (Length and area of service and any specific example of an exceptional commitment made to the University)

2. Include information on additional volunteer service within the nominees profession and/or community and how this may also reflect the nominee’s loyalty and commitment to the University.

3. Provide details regarding the role played in organizations, position held and accomplishments.

Please complete and submit this form by May 1, 2015.
Nominator Agreement

You agree to allow the information provided in the support statement and other information gathered for this purpose to be used by the Brock University Alumni Association and/or Brock University Office of Alumni Relations for publicity and promotional purposes in accordance with the Freedom of Information and Protection of Privacy (FIPPA) Act.

Thank You!

Thank you for taking the time to nominate dedicated volunteer.

If you would like more information about The David S. Betzner Award or have any questions about filling out this Nomination Form, please contact the Alumni office at (905) 688-5550 ext 4327 or email alumni@brocku.ca.