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OTM Nomination

OTM Program Nomination

Program of the Month

Program Category (Please Check Only One).

Community Service Educational Diversity Social

Nominee's School: Region:

Program Title:

Person(s) in charge of program:

Address:

Phone:

E-Mail:

Nominator:

Address:

Phone:

E-Mail:

Target Population (in numbers):

Number of people in attendance:

Number of people needed to organize:

On-Campus Population:

Time needed to organize:

Date(s) of program:

Cost of program:

Origin of program:

Please give a short description of the program (not to exceed 400 words):

Word Count (400 max.):

Goals of the program:

Word Count (200 max.):

Positive and lasting effects of the program:

Word Count (200 max.):

Short evaluation of the program:

Word Count (200 max.):

How could this be adapted to other campuses?

Word Count (200 max.):

Nominations must be typed in a readable font on this form in the space provided above and must not exceed 200 words unless otherwise specified. Nominations not following this format may not be considered for a national award. No additional material will be considered.