Online Nomination Form for

Outstanding Middle & High School Students

Directions

To nominate a qualified student, please complete the form below. Click on "Nominate Additional Students" to recognize additional nominees (There is no minimum or maximum number of students you can nominate. Some schools/organizations nominate only one, others as many as 10 or more). Once you have finished nominating students, please click the "Submit" button.

NOMINATOR INFORMATION



Title	First Name	Middle Initial	Last Name

Nominator Type

NOMINATOR
CONTACT	School/Organization/Employer
INFORMATION
	Title/Position

	Preferred Mailing Address

	City	State	Zip

	Phone ( ) -	Fax ( ) -
	E-mail

NOMINEE/STUDENT INFORMATION


NOMINEE #1
	First Name	M.I.	Last Name

	Home Address

	City	State	Zip
	E-mail
	Current School Name
	Current grade in school :

	Nominate to the following program(s):
	CivicWeek (Spring, for 9th-12th grade students)
	Civic Leadership Institute (Summer, for 10th-12th grade students)
	Youth & Society (Summer, for 7th-9th grade students)
	All programs & courses for which student is eligible

	How long have you known the student and in what capacity? Also, please feel free to share any additional information that you would like us to know about this student and their match for the program.

Top

Civic Education Project
617 Dartmouth Place, Evanston, Illinois, 60208-4175
Phone: (847)467-2572, Fax (847)491-3394, E-mail: cep@northwestern.edu