The personal information that you provide on this form is being collected under the authority of the Post-Secondary Learning Act and the Freedom of Information and Protection of Privacy Act of Alberta. It will be used for the purpose of selecting the recipients of Red Deer College Student Awards. The information will be protected in compliance with the provisions of the Freedom of Information and Protection of Privacy Act of Alberta. The personal information of the award recipient will be shared with the donor of the award and may be shared with the media. This information will be retained for a period of three years, after which it will be destroyed in a secure manner. If you have any questions about the collection and use of this personal information, contact Student Funding and Awards, Red Deer College, 100 College Blvd, Box 5005, Red Deer, Alberta T4N 5H5. Phone 403.342.3254.

·  Awards are given ONLY if funds are available

·  It is necessary to select an alternate recipient as the first recipient could become ineligible for the award

·  GPA and credits should be for the Fall and Winter terms

·  Awards criteria is attached

·  If you require data to select recipients, please contact the Student Funding and Awards office

·  Return this completed nomination form to the Student Funding and Awards office

NAME OF AWARD

NOMINEE INFORMATION

Recipient #1

NAME OF RECIPIENT / STUDENT ID NUMBER
PROGRAM OF STUDIES
STATUS / Full time / Part Time / GPA / CREDITS
REASON FOR SELECTION

Recipient #2 (if applicable)

NAME OF RECIPIENT / STUDENT ID NUMBER
PROGRAM OF STUDIES
STATUS / Full time / Part Time / GPA / CREDITS
REASON FOR SELECTION

Required Alternate Recipient (to be used only if original selection is not eligible)

NAME OF RECIPIENT / STUDENT ID NUMBER
PROGRAM OF STUDIES
STATUS / Full time / Part Time / GPA / CREDITS
REASON FOR SELECTION

NOMINATOR INFORMATION

NAME OF NOMINATOR (PLEASE PRINT) / SIGNATURE OF NOMINATOR
DATE

03/10