2009-2010 Who's Whos in American Colleges and Universities

Qualification Form
Congratulations! You have been nominated for possible inclusion in the next edition of Who’s Who Among Students in American Universities and Colleges. This nomination is a singular honor. In fact, only a small percentage of students are finally selected, so please take the time to carefully complete this form. Please send the form to the Office of the Registrar by clicking on "Submit" at the bottom of the page. The deadline is November 19, 2009. For additional information about Who’s Who, please visit their web site http://www.whoswhoamongstudents.com/

Nominee's Name:
Nominee's Telephone Number:
Eagle ID Number (Last 4 digits only):
Local Address:
Home Address:
Hometown Newspaper:
Classification: Junior        Senior
Major:
Indicate Grade Point Average
(a minimum of 3.0 is required for consideration)    

I. SERVICE TO THE UNIVERSITY CAMPUS ORGANIZATIONS AND SOCIETIES:
List all organizations you have been a member of at Georgia Southern University. (SGA, Honor Societies, Greeks, Religious, Professional, etc.)

Name of Organization
Years of Membership
Office(s) Held
Committee Membership

II. UNIVERSITY ACTIVITIES:
List all university activities you have participated in other than those listed above (Theatre South, Debate Team, GSU Chorus, Athletic Teams, Marching Band, Cheerleading, etc.)

Activity
Year(s)

III. CAMPUS AWARDS AND RECOGNITIONS:
(Model UN, Deans List, Outstanding Member, Leadership Awards, etc.)

Activity
Type of Involvement
Year(s)

IV. SERVICE BEYOND THE CAMPUS LEVEL:
List any involvement with volunteer community service to non-profit organizations.

Organization
Type of Involvement
Year(s)

V. WORK EXPERIENCE
(While in college)
     

VI. LIST BELOW ANY OTHER SIGNIFICANT CONTRIBUTION OR ACHIEVEMENT THAT HAS NOT ALREADY BEEN LISTED THAT YOU WISH THE COMMITTEE TO CONSIDER.
Specify full information.
     

VII. PLEASE LIST THREE FACULTY/STAFF REFERENCES, INCLUDING ALL CONTACT INFORMATION:

     Name:
     Telephone Number:
     E-Mail:

     Name:
     Telephone Number:
     E-Mail:

     Name:
     Telephone Number:
     E-Mail:

Any Additional Information: