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On Campus

NOTE: Please provide FULL first names, or two initials. One initial is not acceptable.

For dean’s list include a copy of student’s grade report or a copy of the congratulatory letter from the dean.

For award include a copy of the award or congratulatory letter from the dean.

For graduation include a copy of the front cover of the commencement program and a copy of the page in which the student’s name appears.

Student's Name: *

Parent(s) Name: *

Town: *

Dean's list semester:

has been named to the dean's list for the ____________ semester, received and academic award, or has graduated from

College/university: *

College town: *

College state: *

Is majoring in:

Degree pursuing:

Activities:

Academic awards:

He/she is a graduate of: *

High School

High school town: *

Year of high school graduation: *

Daytime telephone #:

Evening telephone #:

Cell phone #:

email address: *

Documentation:

For dean’s list include a copy of student’s grade report or a copy of the congratulatory letter from the dean.

For award include a copy of the award or congratulatory letter from the dean.

For graduation include a copy of the front cover of the commencement program and a copy of the page in which the student’s name appears.

Additional documentation: