Published on Brock University (http://www.brocku.ca)

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, cosc, ‘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

Name: *

Address: *

Postal Code: *

Area Code and Phone Number: *

Please Check: *

Faculty

Staff

Graduate

Student

Candidate

Candidate's Name: *

Phone Number: *

Check each item at the point on the scale that best indicates your rating of the nominee as compared to his/her peers

Please Provide a Description of the Nominee's Volunteer Service : *

• Pay particular attention to the focus of the award: supporting Brock University and/or the Alumni Association through continuous dedicated volunteer service.
• The nominator should indicate how the nominee’s volunteer service has made a difference to the University, by giving particulars of the length of service, areas of service and any specific examples of the nominee’s exceptional commitment to the University.
• The nominator may also include information on the nominee’s other volunteer service in their profession and/or community and how this may also reflect the nominee’s loyalty and commitment to the University.
• Be specific and provide details regarding the role played in organizations, position held and accomplishments.

Please complete and submit this form by May 1, 2012

Thank you

Source URL: http://www.brocku.ca/alumni-association/recognition/student-awards/betznerawardnomform