Program OTM Nomination Form

Month:
May		 Year:
2013
Category:

Click here for a description of the categories
Nominee's School:
SUNY Stony Brook		 Region:
NEACURH
Nominee's organization:

Person in Charge:

Address:


Phone:

Email Address:

On-Campus Population:
9000
Nominator's organization:

Nominator:

Address:


Phone:

Email Address:

Chapter Size:
60
Program Title:
Target Population (in numbers):

Number of People in Attendance:

Number of People Needed to Organize:

 Time Needed to Organize:

Date(s) of Program:

Cost of Program:

Origin of program:

Word Count (200 Maximum):

Please give a short description of program:

Word Count (400 Maximum):

Goals of program:

Word Count (200 Maximum):

Positive and lasting effects of the program:

Word Count (200 Maximum):

Short evaluation of the program:

Word Count (200 Maximum):

How could this program be adapted to other campuses?

Word Count (200 Maximum):

World Wide Web nominations must be typed on this form and each area
must not exceed maximum word count specified. 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
th of the month following the month of nomination.

Revised May 1999

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