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Service Learning &
Civic Engagement
Collaboration Awards

 
  
Nomination Form

PLEASE COMPLETE THIS FORM AND THEN SELECT "Print" ON THE MENU AT THE TOP OF THIS SCREEN TO PRINT YOUR COMPLETED FORM.

Today's Date
Name of Institution
Contact Person
Work Phone:
Work Fax:
E-mail
Street Address
City
State Zip Code:

TYPE OF AWARD:

PLEASE ATTACH:

  • This Form

  • A Nomination (not to exceed five (5) double-spaced pages) identifying how this collaboration aligns with the nomination criteria by describing the following:
    • quality of learning opportunities provided to students
    • contribution of both the institution and its partner(s) to community improvement
    • level of faculty involvement in the collaboration
    • development of the collaboration, its impact on the community, and how it can encourage others to develop similar partnerships
    • any other pertinent information that should be considered by the selection committee

  • Two Letters of Support
    • Community College President or Lead Project Administrator
    • Collaborating partner

TO SUBMIT NOMINATION:

PLEASE PRINT A COPY OF THIS COMPLETED FORM AND MAIL 2 (TWO) COPIES OF IT AND THE ATTACHMENTS LISTED ABOVE TO:

Lyvier Conss, Executive Director
Community College National Center
for Community Engagement
1025 North Country Club Drive, Room 320
Mesa, Arizona 85201
480-461-6281

DUE DATE:

Nominations must be received by February 12, 2010. FAXES OR E-MAIL WILL NOT BE ACCEPTED.