21st Century Leadership Award Nomination

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

Country
Street
City
Region
Postal Code

Student Home Phone Number

Student Birthdate*

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

Counselor First Name*

Counselor Last Name*

Title*

School Name* Type in the name of your institution to select 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 award certificate for each student. We typically send this directly to the counselor who submitted the nomination. If applicable, please provide the date of your awards ceremony so the certificate(s) can be mailed in a timely manner.

Date of School's Honors Award Program

Additional Notes: Is there anything else we need to know about you, your student, your school or awards ceremony?