Nominee’s Name:          G #:

Year in School:       Major:

Please indicate the award category for which you are nominating this student. Refer to the Leadership Awards Criteria and Categories.

Use only the space provided on this form and do not attach additional pages.

Outstanding Student Leadership Award for exceptional contributions in the following area:

Outstanding Contribution to Community Service
Outstanding Contribution to Peer Education
Outstanding Contribution to Student Governance
Outstanding Contribution to Student Club and Organization Leadership
Outstanding Contribution to Non-Traditional Student Services
Outstanding Contribution to Disability Services
Outstanding Contribution to the Celebration and Promotion of Diversity
President’s Award for Student Leadership
The Spirit of Missouri Western Award (Student Organization)

Please answer the following three questions about this student, to the best of your knowledge:

1. List the leadership roles held this year and/or examples of the student’s most noteworthy accomplishments.

2. Explanation of how these contributions merit an Outstanding Student Leadership Award in this category.

3. If this individual is an employee of your department, explain how the leadership contributions are unique and have gone above and beyond the normal expectations of an employee in this position.

Nominator’s Name:

Title:

Please submit form no later than Friday, March 13, 2009.