MIGRANT PASS STUDENT OF THE YEAR
NOMINATION FORM
Directions: Please provide the following information for each student nominated.
Nominations are limited to two (2) per state.
Student Name:______
Address: ______
______Phone______
Anticipated High School Graduation (MM/YY) ______
School Currently Attending School Attended During Summer (if appropriate)
______
PASS Course(s) Taken: ______
______
______
______
Contact Person:______Title:______
Address: ______
______
Phone: ______
Fill in the student profile on the back of this sheet. In addition to the profile information, nominations must include the following:
Copy of student’s Certificate of Eligibility
Student essay of 300-500 words telling about educational and career goals and how PASS has helped (10 points)
Student and parent signature, if required, where indicated on the back of this sheet
Please provide a clear photo of the nominee (head and shoulders with an uncluttered background) for printing in the PASS Success Stories booklet and the National PASS Center web site.
Completed applications and attachments must be submitted annually to the National PASS Center no later than February 7th.
MIGRANT PASS STUDENT OF THE YEAR
STUDENT PROFILE
(to be completed by contact person or PASS mentor)
Scoring Criteria
5 points per section below = 25
A. Family history of migration: (5 points) student essay = 10
Total possible points 35
B. Why did the student need PASS? (5 points)
C. What academic successes has the student achieved, i.e. credits earned, scholarships, awards, honors, etc.? (5 points)
D. In what extracurricular activities, family/work responsibilities and/or accomplishments has the student been involved? (5 points)
E. Tell why you feel the nominee is an exemplary PASS student. (5 points)
I agree to the use of my name, photograph and/or the information contained in this application by the National PASS Center (NPC) for publication in PASS related materials including the annual PASS Success Stories booklet and the NPC web site.
______
Student signature Date
______
Parent signature if student is under 18 years old
(Attach additional sheets as needed)
SF 4/16/2013