Address:

Phone:

Email Address:


On-Campus Population:
500

Address:

Phone:

Email Address:

Chapter Size:
Small

Please explain the outstanding contributions of the nominee during the month of nomination
(i.e., how the nominee addressed recognition, motivation, and support for you or your organization).

Word Count (600 Maximum):

World Wide Web nominations must be typed on this form and must not exceed 600 words.
Nominations not following this format may not be considered for a national award.
No additional material will be considered. Nominations must be submitted by midnight
on the 12th of the month following the month of nomination.

Please give a short 3-4 sentence summary of this OTM.