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

Silver Badger Award Nomination Form

Requirements

You are applying for the Silver Badger Award. In order to complete nomination process you must:
1) Complete and submit the following nomination form by May 1, 2012
2) Select a referee who can corroborate your efforts and provide your referee with an electronic copy of the Silver Badger Award Confidential Assessment Form, located at www.brocku.ca/alumni-association/recognition/student-awards/silverbadgco... [1]
3) In order to determine financial need, complete an on-line application available on the Student Awards and Financial Aid website https://my.brocku.ca/BrockDB/gnrl_questionnaire.aspx?QID=10 [2]

To be eligible for this award, the student must fulfill the following requirements:

a) the student must have made a meaningful contribution to the development of extracurricular life within the community
b) the student must be presently registered full-time at Brock and have successfully completed five or more credits in the previous fall/winter sessions
c) the student must have achieved an average of B in his/her major
d) the successful candidate must demonstrate financial need and meet the Ontario residency requirements of the Ontario Student Assistance Program. Financial need will be determined by completion of an on-line application available on the Student Awards and Financial Aid website https://my.brocku.ca/BrockDB/gnrl_questionnaire.aspx?QID=10 [2]

Name: *

Student ID # : *

Email Address: *

Major: *

Year of Study: *

Fourth Example

Area Code and Phone Number: *

Name of Referee

Position: *

Address: *

Phone Number: *

Please provide a description of your extracurricular activities within the Brock University community.

Be specific and provide details regarding the role played in organizations, position held and accomplishments.

First Example

Type of Involvement/Position Held (eg. Student club/org. University Committees, Athletics, etc) : *

Key Contributions: *

Duration (# of hour/wk, term or month or # of month or years) : *

Type of Participation: *

Volunteer

Paid

For Academic Credit

Second Example

Type of Involvement/Position Held (eg. Student club/org. University Committees, Athletics, etc): *

Key Contributions : *

Duration (# of hour/wk, term or month or # of month or years) : *

Type of Participation: *

Volunteer

Paid

For Academic Credit

Third Example

Type of Involvement/Position Held (eg. Student club/org. University Committees, Athletics, etc) : *

Key Contributions : *

Duration (# of hour/wk, term or month or # of month or years) : *

Type of Participation : *

Volunteer

Paid

For Academic Credit

Type of Involvement/Position Held (eg. Student club/org. University Committees, Athletics, etc) : *

Key Contributions : *

Duration (# of hour/wk, term or month or # of month or years) : *

Type of Participation : *

Volunteer

Paid

For Academic Credit

For each extracurricular activity listed above, please provide...

Name of verifier from 1st activity/position held: *

Phone number of 1st verifier: *

Email address of 1st verifier: *

Name of verifier from 2nd activity/position held: *

Phone number of 2nd verifier: *

Email address of 2nd verifier: *

Name of verifier from 3rd activity/position held: *

Phone number of 3rd verifier: *

Email address of 3rd verifier: *

By completing and submitting this form

You are providing consent for the BUAA to verify your eligibility for this award.

This may include, but is not limited to, obtaining information from:

• the Office of the Registrar, Student Award and Financial Aid at Brock University
• any Brock University Department listed in your application
• any individuals listed as a verifier or referee

In order for your nomination to be considered

All components of the application must be received by the BUAA by May 1, 2012

Thank You

Thank you for applying for the Alumni Association Silver Badger Award. Best of Luck!

Source URL: http://www.brocku.ca/alumni-association/recognition/student-awards/silverbadgerawardnomform-2