(* Required)     
Nominee: *   

Email: *   

Local Address: *   

City, State & Zip Code: *   

Campus/Cell #: *   

Major: *   

Student Organization/Club: *   

Advisor: *   

Hometown Newspaper    

NOTE: A minimum GPA of 2.25 is required of the nominee; however, service is the principle criterion for the award.   
Campus Activities:   
Please list Academic Year; Organization; and Office Held *       
Community Activities:   
Please list Academic Year; Organization; and Office Held *       
REASONS FOR NOMINATION: *       
   

Questions? Contact Andee Dunham at adunham@mansfield.edu or Alumni Hall Room 323.