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Champions of Diversity Nomination Form

    Skagit Valley College in partnership with Central Washington University, Eastern Washington University, The Evergreen State College, North Cascades Institute, University of Washington Bothell, University of Washington Seattle, University of Washington Tacoma, Washington State University, and Western Washington University seeks nominations for 10th - 12th grade students from Skagit, Island and San Juan County high schools who have contributed to diversity on their campuses and in their communities.

    Nominated seniors will be considered for scholarships offered by public colleges/universities in the state of Washington. Nominations are due by noon on Tuesday, October 15, 2013. Selected students will be honored Wednesday, December 4, 2013 at the Champions of Diversity Awards Ceremony to be held in McIntyre Hall, Skagit Valley College, Mount Vernon, WA.

    If you have any questions about the nomination form or process, please contact Anita Ordoñez, anita.ordonez@skagit.edu at: 360.416.7786.

    Note:Use the Tab button to move to the next form field. Use the Next/Back buttons below to move through the form pages.(Not your browsers forward/back buttons)

    Page 1 of 3 (Award Nomination) Page 1 of 7 (Scholarship Nomination)

    Nomination Principles for COD Awards

    In order to nominate your student for Champions of Diversity, you must read over and confirm your understanding of the following-

    1. Maximum number of nominations: Each nominator may nominate three seniors for scholarships and two sophomores/juniors for awards. Seniors are not eligible for awards.
    2. Please link to and read the: Reasons to Nominate Students for Champions of Diversity Awards

    I have read and understand the Nominating Principles for COD Awards and/or Scholarships which includes the Reasons to Nominate Students.
    Date:

    Page 2 of 3 (Award Nomination) Page 2 of 7 (Scholarship Nomination)

    Nominator Contact Information

    Email:
    Confirm Email:
    Phone Number:() Extension:

    Are you nominating a Senior for a scholarship?
    (No = Proceed with the three page award nomination form, Yes = Proceed with seven page scholarship nomination form) Save Nominator InfoDelete Nominator Info

    Page 3 of 3 (Award Nomination)

    Champions of Diversity Award Nominee Information

    Cell Phone Number:()
    Home or Family Phone:()
    Career goals/future aspirations/intended degree or certificate:

    How long have you known this student and in what context? (For script purposes)
    Character Count - 100 characters maximum:

    List 8-10 words that come to your mind to describe this student. (For script purposes)
    Character Count - 150 characters maximum:

    Describe the nominee's academic, extracurricular, volunteer, community service and/or leadership activities. (For script purposes)
    Character Count - 1000 characters maximum:

    If the information below looks correct, please click submit button at the bottom of this page. If you'd like to make a change please use the back button to go back and make changes.

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    My nominee is a 12th grader and therefore eligible for a COD scholarship. Yes

    Page 3 of 7 (Scholarship Nomination)

    Scholarship Nomination Strategies

    In order to nominate a senior for the Champions of Diversity Scholarship, you must read over and confirm your understanding of the following -

    Scholarship Guidelines

    • Please limit your scholarship nominations to three seniors.
    • Make sure the student meets the minimum 2.0 GPA.
    • Scholarships to each college are limited.  Therefore, always mark 3 schools that your student would like to consider attending, keeping in mind what is offered at the college or university of their choice.

    Examples of what Universities and SVC are looking for in a scholarship nominee

    • Demonstrating a commitment to community service and leadership
    • Demonstrating cultural awareness or unique perspectives or experiences
    • Demonstrating notable tenacity, insight, originality or creativity
    • 1st generation college student (neither parent has a 4 year college degree)
    • Exercising significant responsibility in a family, a community, employment or through activities
    • Attaining a college prep education in the face of significant personal adversity, economic disadvantage (free or reduced lunch) or disability
    • Information regarding the nominee's attendance at campus tours, university events, or educational programs(i.e. Nurse Camp, U-Doc, "The Summer of Excellence")

    Date:

    Page 4 of 7 (Scholarship Nomination)

    Champions of Diversity Scholarship Nominee Information

    Cell Phone Number:()
    Home or Family Phone:()

    Page 5 of 7 (Scholarship Nomination)

    I would like to nominate this high school senior for a scholarship from the following schools:

    Central Washington Univ, Ellensburg
    Eastern Washington Univ, Cheney
    Skagit Valley College
    The Evergreen State College, Olympia
    Univ of Washington, Bothell
    Univ of Washington, Seattle
    Univ of Washington, Tacoma
    Washington State Univ, Pullman
    Western Washington Univ, Bellingham

    We recommend that the student submit admissions applications to the colleges of their choice.

    Page 6 of 7 (Scholarship Nomination)

    Student is not interested in attending Skagit Valley College

    Student is interested in attending SVC and would like to be considered for a scholarship in one or more of the following areas: 

           Allied Health (Med-Asst, Pharm-Tech, Phlebotomy)
           Automotive Tech
           Early Childhood Education
           Pre-Engineering
           Human Services
           Nursing
           Science
           Radio
           Welding/Manufacturing

    Student is interested in attending SVC, but not in any of the areas listed above.

    Page 7 of 7 (Scholarship Nomination)

    For your nominee to be considered for scholarships, you must fill in the following text boxes, clarifying why your nominee is a Champion of Diversity. We suggest you compose your responses in a separate document and then copy and paste them into the text boxes below. Each text box holds a limited number of characters.

    Provide comments that will help us differentiate this student from others.

    (For script purposes) Character Count (1000 characters maximum):

    Describe the nominee's personal characteristics including diversity components.

    (For script purposes) Character Count (1000 characters maximum):

    Describe the nominee's academic, extracurricular, volunteer, community service and/or leadership activities.

    (For script purposes) Character Count (1000 characters maximum):

    Confidential:Particularities of family situations or responsibilites, or other circumstances, either positive or negative.

    (To be used only in deliberation for scholarship, not for script) Character Count (1000 characters maximum):

    Career goals/future aspirations/intended degree or certificate:

    How long have you known this student and in what context?

    (For script purposes) Character Count - 100 characters maximum:

    List 8-10 words that come to your mind to describe this student.

    (For script purposes) Character Count - 150 characters maximum:

    If the information below looks correct, please click the submit button at the bottom of this page. If you'd like to make a change please use the back button to go back and make changes.

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