Campus Activities and Recreation

CHANCELLOR'S LEADERSHIP AWARD
ALBERTSON MEDALLION AWARD

Please Enter the first three letters of your last name:        
Name:

Phonetic Spelling of Last Name (Ex.- Baeseman = Baze-men):

Local Address:

Name and address of parents:
 Name(s):

Address:

Name of spouse (if applicable):
 Name:

Names of children (if applicable:
 Name(s):

Major Area of Study: Minor Area of Study:

Cumulative Grade Point Average: Date of Graduation:

1. List the campus activities in which you VOLUNTEERED while in college:
(Organization or Activity | Year(s) of participation | Office Held, if any | Level of responsibility [1 = low 2 = medium 3 = high])

2. List the campus activities you participated in that were PAID POSITIONS while in college.

3. List any honors or recognitions you have received while in college (e.g., scholarships, awards, articles published in journals or magazines, etc.).

4. List any additional responsibilities or accomplishments which could be considered by the Selection Committee. (Teaching Assistant, Native American Tutoring, Orientation Leader, Residence Hall Staff, Community or Hometown Activities while in college, etc.).

5. For the purpose of this exercise, the university has been using a broad definition of leadership put forth by Warren Bennis and Burt Nanus who suggest that leaders are people who:

-have a strong sense of purpose. -are magnetic and draw in others.
-are very persistent. -treat others with respect and caring.
-seek to know themselves. -take risks and like to experiment.
-are always learning. -see mistakes as opportunities.
-find a sense of joy in their work. -serve the needs of others.

How do you feel your activity on this campus meets or exceeds this definition?

6. We define campus/community service as the unselfish giving of oneself in serving the common good of our campus/community, and the quality of an individual's response to membership or citizenship through their campus/community contributions. In what ways do you feel your campus/community service meets or exceeds this definition?

7. We define personal growth as the degree to which students have attended workshops, participated in seminars, demonstrated mature decision-making/problem solving abilities, and taken on campus/community experiences which demand graduated amounts of personal or professional sophistication. How would you say your personal growth experiences on this campus meet or exceed this definition?

If chosen as a recipient of the Chancellor's Leadership Award or the Albertson Medallion Award, how would you like your name inscribed in the medallion?

If selected as a recipient of the Chancellor's Leadership Award or the Albertson Medallion Award, I grant permission to release the information I have provided on this questionnaire.
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Stevens Point, WI 54481
www.uwsp.edu