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21st Century Leadership Award Nomination
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Source of Inquiry*
Source of Inquiry*
Source - JLA Nomination
Student Type
Student Type
First-Year Student
HS Graduation Year
HS Graduation Year
2023
The deadline for nominations is Friday, April 22, 2022. Award certificates will be mailed on a rolling basis.
Nominate two students from your school to receive the Wells College 21st Century Leadership Award. This award honors top academic performers who have the passion and integrity needed to become successful leaders. Please complete this form for each student nominee.
This award is reserved for students with junior (11th grade) standing only.
Nominated Student Information
Student First Name*
Student Last Name*
Student Current Mailing Address
Student Current Mailing Address
Country
Street
City
Region
Postal Code
Student Home Phone Number
Student Birthdate*
Student Birthdate*
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Student Primary Email Address*
For data integrity, please list the student's email and not that of a staff member. Students will NOT be notified of their nomination.
Student Weighted Cumulative GPA
Please upload a copy of the student's official transcript.
Multiple or paper copies are not required.
Please list the student's involvement in clubs, organizations and volunteer activities.
Note:
As an NCAA Division III college, we can NOT consider athletic participation when selecting candidates for this award.
Extracurricular Activities
Guidance / College Counselor Information
Contact information for the person submitting this nomination.
Counselor First Name*
Counselor Last Name*
Title*
School Name*
Type in the name of your institution and SELECT it from the drop-down list. You can also enter the CEEB code to search for your school
CEEB
Please verify that this CEEB code corresponds with your institution name above.
Email*
Phone
If your phone number includes an extension, please let us know in the notes section below.
If selected for the award, Wells College will provide a special certificate for each student. We typically send this via USPS directly to the counselor who submitted the nomination. Please provide the date of your awards ceremony to ensure the certificate(s) can be mailed in a timely manner.
Date of School's Honors Award Program
Date of School's Honors Award Program
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Additional Notes:
Is there anything else we should know about you, your student, your school or awards ceremony?
Submit
The following email addresses are a honeypot intended to test automated bots' ability to parse encoded addresses. Please do not contact these addresses.
sgamgee@wells.edu
fbaggins@wells.edu