COMU Award Category:

Undergraduate Student
Graduate Student
Faculty Member
Staff Member
Community Member
Outstanding Program
             Name of Program:

Name of Nominee (or Contact Name if for Outstanding Program):

Nominee's Address:

Nominee's Phone Number:

Nominee's Email Address:

Nominee's Class Standing or Department/Office:

Rationale for Nomination:

Information about Nominator

Your Name:

Relationship to Nominee:

Your Address:


Your Phone Number:


Your Email Address:

Your Class Standing or Department/Office: