VICTOR A. BATTISTICH MEMORIAL GRADUATE AWARD

NOMINATION FORM | DEADLINE MARCH 15TH ANNUALLY | $500

I am applying for

Myself

Nomination for someone else

The nominee is a current Graduate Student at UMSL

Only current UMSL graduate students are eligible.

Yes

No

About the Applicant / Nominee

Nominee's Name

First Name

Last Name

Nominee's Email

Nominee's Address

City

Zip Code

Country

Nominee's Phone Number

(###)

###

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Why should you (or this person) be considered for the Battistich award?

Be specific. How does this student fit the criteria such as: high quality work in character education, school climate, prosocial development, prevention science, democratic values in education, program evaluation of character or other positive youth development education programs. What is unique about this student?

Is there anything else you would like to add?

About the Nominator (if nominating someone else)

If you are nominating someone else, what is your relationship to the Applicant?

Nominator's Name

First Name

Last Name

Nominator's Email

Nominator's Daytime Phone Number

(###)

###

####

A CCC staff member will be in touch with you after you submit the application. Please e-mail us at ccc@umsl.edu if you have any questions.

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