Distinguished Senior Award Nomination 2024

To submit a nomination, please complete and submit this form by Friday, March 29, 2024. Please complete each field to the best of your abilities. Submit only one nomination per form.

Student's Name Student's Name * Title First Last Suffix
Student's E-Number
Student’s Campus Address Student’s Campus Address
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Student’s Phone Number Student’s Phone Number - ### - ### ####
Student’s EIU Email Address *
Student’s Major
Student’s Minor
Student’s Expected Graduation Date

Student’s Expected Graduation Date Spring 2024 Summer 2024 Fall 2024
Nominator’s Name Nominator’s Name * Title First Last Suffix
Nominator's Address Nominator's Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Nominator’s Phone Number Nominator’s Phone Number * - ### - ### ####
Nominator’s Email Address *
EIU Affiliation *
Relation to Nominee *
List student's campus organizations and activities (the student will be contacted to complete this portion):
List student's participation in organizations and activities outside the campus community while attending EIU (the student will be contacted to complete this portion):
List of honors and/or awards student received while attending EIU (the student will be contacted to complete this portion):
Describe why you believe this student is deserving of the Distinguished Senior Award: *