Student Supporting Nomination

Student's First and Last Name*
First Last
Name of Project/Activity to which criteria will apply*
Position*
Year in School*
Length of time Student has been involved with project/activity
Student's Phone Number*
Student's Address
Street Address Address Line 2 City State ZIP Code
Student's Email*

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Brief Description of how the Project or Activity Works*
School Affiliation (can be private or public within Lake Oswego)
Is this a New or Ongoing Project/Activity
Project/Activity Start Date (estimate if needed)
Will this Project or Activity Continue into the Future?
Number of People Benefited (estimate if needed)
How are You Familiar with this Person's Service to Others in Support of Education? (What is your connection to the Nominee?)

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Shows initiative, yet demonstrates selfless conduct toward others (give examples where you can).
a) How did Student initiate the project/activity or show personal initiative in performing it?
b) How much time did Student invest in the project/activity?
c) Does the project/activity meet a school need? How?
d) Does the project/activity meet a community need? How?
e) How is the Student an inspirational leader who engenders support of other involved stakeholders?
Inspires others to reach a high level of educational excellence (give examples where you can).
a) Does the Student create a positive learning environment that impacts others?
b) How does the project/activity involve critical thinking?
c) How does the project/activity demonstrate and engender high educational ideals?
d) Did project participants learn new skills through their involvement with the project?
Builds a strong sense of confidence, competence, and citizenship in others (give examples where you can).
a) How did the project/activity encourage mutual trust and empowerment?
b) How was the Student effective in communication, organization, creativity?
c) How did the Student motivate citizenship in others?
d) How many people were involved in participating in or completing the project/activity?
Creates positive, results-driven impact that could continue beyond the Student's involvement (give examples where you can).
a) Has the project/activity been a measurable success (if possible, provide numbers)?
b) How will it be measured in the future?
c) How did Student's project/activity result in a sustainable model for others to follow?
Participates in a high level in other extracurricular & school-related activities (give examples where you can).
a) In which extracurricular and school-related activities is the Student most involved? How?
b) In which does the Student have a significant or leadership role? How?
c) In what other community activities outside of the classroom does the Student participate?
Is there anything you would like to add that is not addressed in your answers above?

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Supporting Nominator Name*
First Last
Supporting Nominator Address
Street Address Address Line 2 City State ZIP Code
Supporting Nominator Phone Number*
Supporting Nominator Email*

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Student Supporting Nomination

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Nominee Information

Student Supporting Nomination

Student Supporting Nomination

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Nominee Information

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