Ithaca College Center for Student Leadership & Involvement

Peggy R. Williams Award for Academic and Community Leadership Application

You must be a nominated junior or senior to apply for this award. Any Ithaca College faculty member, staff member, or student may nominate an outstanding junior for the Peggy R. Williams Award for Academic and Community Leadership by submitting the online form. Nominations must be received by 5:00 p.m. Friday, November 16, 2007.

Only those students who complete the following application will be considered. Please note that all fields are required. APPLICATIONS ARE DUE WEDNESDAY, Wednesday, November 28, 2007 BY 5 PM.

First Name

Last Name

Middle Init.

Name to appear on certificate

Local Address

Local Telephone

Home Address

Home Telephone

Email Address

Class Standing

Number of Semesters at IC

Ithaca College GPA

Expected Graduation Date

Major 1

School

Major 2

School 2

Faculty Advisor

Are you a transfer student?

Yes No

If yes, how may credit have you earned at Ithaca College?

Please list those activities which you have participated at Ithaca College. If none, write "none".

1. Academic

Please list activities in organizations within your school or department, including contributions through performance in activities, clubs, honor societies, advisory boards, etc. Include with each activity: academic year, number of semesters you were involved, activity, any leadership positions you may have held, and the number of semesters you held those leadership positions. (Participation in academic clubs may be included in this section or in section 2.)

2. Recognition and/or activities outside academic school or department

Activities in organizations outside your academic school or department: include athletics, drama, music (nondepartmental majors), campus-wide clubs and organizations, Student Government, All-College Committees, papers, publications and selection to All-American, etc. Include with each activity: academic year, the number of semesters you were involved, activity, any leadership positions and the number of semesters you held those leadership positions.

3. Community service involvement off campus

Please list all community service activities in which you have been involved in. Include with each activity: academic year, the number of semesters you volunteered, and the agency.

4. Paid activities on campus for which there is a very selective procedue

Please list all positions at Ithaca College for which you received financial compensation. Please include the semesters you worked. (Paid Dana Internships may be listed here.)

Please tell us why you feel you should be a recipient of the Peggy R. Williams Award for Academic Leadership.

In no more than 200 words, please tell us why you should be selected for this award.

Submitting this form will send this data to a review committee. You will receive a confirmation page if your application has been submitted successfully. You must print out the information release form provided on the confirmation page and submit it to the Center for Student Leadership & Involvement, 319 Egbert Hall in order for your application to be considered complete.

319 Egbert Hall • (607)274-3222 • csli@ithaca.edu
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Last Modified: November 6, 2007