BUFFALO STATE COLLEGE
StateUniversity of New York
UNDERGRADUATE AND GRADUATE
PRESIDENT'S MEDAL FOR OUTSTANDING STUDENT &
SUNY CHANCELLOR'S AWARD FOR STUDENT EXCELLENCE
The Student Information Form follows on the next page.
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BUFFALO STATE COLLEGE
State University of New York
UNDERGRADUATE AND GRADUATE
PRESIDENT'S MEDAL FOR OUTSTANDING STUDENT &
SUNY CHANCELLOR'S AWARD FOR STUDENT EXCELLENCE
STUDENT INFORMATION FORM
Banner ID: / GPA:Last Name: / First Name: / MI:
Permanent Address (street, city, state, zip code):
Local Address (street, city, state, zip code):
Home Phone (include area code):
( ) - / Cell Phone (include area code):
( ) -
Hometown (including zip code):
Email:
Month/Year Started College: / Month/Year of Graduation:
Major(s): / Minor:
Degree(s) Sought:
Please consider me for:
(please place an “X” next to the award) / ____President’s Medal
____SUNY Chancellor’s Award
____Both
Who is nominating you? Please provide the nominator’s name and title:
Please list the name and title of at least two faculty/staff members (other than your nominator) who are providing letters in support of your nomination:
Please list the name and title of community members who are providing letters in support of your nomination:
Please list three of your major accomplishments during your time at Buffalo State College:
1.
2.
3.
In the boxes below, list below awards, recognition or accomplishments that demonstrate excellence in areas of Academics, Leadership, Campus Involvement, Community Service, Arts, Athletics, Career Achievement and Other. You may enter as many items as you would like for each category, the boxes will expand as you enter. Not every category will be applicable to each student. Some may be left blank. Please include name of award/recognition/accomplishment, name of organization, date received and description of each. Please number each item in each category, as shown below:
1. Name of award/recognition/accomplishment, name of organization, date of accomplishment, and description.
2. Name of award/recognition/accomplishment, name of organization, date of accomplishment, and description.
3. Etc.
4.Etc.
ACADEMIC EXCELLENCE
1.
2.
3.
LEADERSHIP
1.
2.
3.
CAMPUS INVOLVEMENT
1.
2.
3.
COMMUNITY SERVICE
1.
2.
3.
ARTS
1.
2.
3.
ATHLETICS
1.
2.
3.
CAREER ACHIEVEMENT
1.
2.
3.
OTHER
1.
2.
3.
BUFFALO STATE COLLEGE
State University of New York
2018 UNDERGRADUATE AND GRADUATE
PRESIDENT'S MEDAL FOR OUTSTANDING STUDENT &
SUNY CHANCELLOR'S AWARD FOR STUDENT EXCELLENCE
CHECKLIST
1. Send an email to with the following attachmentsand include hard copies in your portfolio:
YesNo
______A.Student Information Form
______B.Personal Statement
______C.Biography
______D.Resume or Curriculum Vitae
______Confirmed that Email with four (4) above attachments sent
2.Deliver your portfolio to the Student Affairs Office, Cleveland Hall room 513, no later than 4:00 p.m. on Monday, December 18, 2017.
YesNo
______