Application

Outstanding Undergraduate Student Award

Application Due: March 12, 2012

Period of Accomplishments: January 1, 2011 – December 31, 2012

Applicant's Name: - Please type applicant's name here -

Applicant’s major and concentration:

- Please type major here-

Signature of Applicant: ______Date: ______

Date received: ______

Received by: ______

Supporting Documentation

Grade Point Average (4.0 scale):

  • In the text box below, please enter the overall grade point average (on a 4.0 scale).
  • 3.00 – 3.25 = 1 point
  • 3.26 – 3.50 = 2 points
  • 3.51 – 3.75 = 4 points
  • 3.76 – 4.00 = 6 points

GPA = None

Extracurricular Activities: (Maximum of 6 points)

  • In the text box below, please list affiliations with professional/student organizations, offices held in professional organizations, offices in Student Government Association, and community service. The text box will expand as you type.

None

References: (Maximum of 6 points)

  • This award application package must include a minimum of three, and not more than five, evaluation formsfrom individuals who can evaluate the applicant’s efforts. At least one reference must be from a faculty/staff member in a discipline other than that of the applicant.

In the box at the left, please enter the number of letters included in this award application packet.
Please provide names and contact information in the text box below. The text box will expand as you type.
- Please enter the name, mailing address, telephone, and e-mail address of each reference here -

Personal Statement:( Maximum of 6 points)

  • Brief statement concerning current involvement in the profession and future contributions.

Presentations: (Maximum of 4 points)

  • In the text box below, please type a complete reference [author(s), year of publication, title, meeting organization, meeting location, meeting date(s)] for each presentation to be evaluated for this application packet. The text box will expand as you type.
  • For each presentation, you must also include and clearly indicate the following information:
  • The type of meeting (professional or non-professional; international, national, or local)
  • Whether the presentation was oral or poster
  • Whether the presentation was refereed or non-refereed
  • Whether the presentation was on-campus or off-campus

None

Awards: (Maximum of 4 points)

  • In the text box below, please type a list of awards received during the period of accomplishments. The text box will expand as you type.
  • For each award, you must include the following information:
  • The name of the award
  • The awarding organization
  • The date of the award
  • The type of award (professional or non-professional; international, national, or local)

None

Publications: (Maximum of 4 points)

  • A reprint or copy of each publication must be included as a supporting document in this application packet.
  • In the text box under the appropriate category below, please type a complete reference [author(s), year of publication, title, publisher] for each publication supporting document included in this application packet. The text boxes will expand as you type.
  • Refereed Publications:

None

  • Non-Refereed Publications:

None

  • Magazine Articles:

None

  • Newspaper Articles:

None

  • Abstracts:

None

  • Proceedings:

None

  • Books:

None

  • Book Chapters:

None

  • Bulletins:

None

  • Other:

None

Submit application form and supporting materials to:

Sue Ballard de Ruiz

Department of Family and Consumer Sciences

107Humphries Building 322

TennesseeStateUniversity

3500 John Merritt Blvd.

Nashville, TN 37209