A Student at (College/University name):
The Nominee appeared in the role of:
In our production of:
At the time of the production, the nominee was a bona fide student in one of the following catagories :
Graduate - (A graduate student enrolled for at least 3 semester or 4 quarter hours)
Undergraduate - (An undergraduate enrolled for at least 6 semester or 9 quarter hours)
Cont/Part Time - (A continuing part-time student enrolled in a regular degree or certification program)
Name of Production Director :
Name of Department Chair :
*The two individuals named above vouch that the information on this form is accurate and true.
Faculty Coach/Coordinator/Contact email address :
Faculty Coach/Coordinator/Contact name :
*Nominee's Email Address:
A value is required.Invalid format.