Family of the Year Nomination

Student Information

Student's Name:

Student's Email:

Student Permanent Address:

City:

State:
- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP Code:

Cell Phone:

Best time to call:

Hometown:

High School:

Family Information

Parent(s)/Guardian(s) Name:

Parent(s)/Guardian(s) Address:

City:

State:
- Select - Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming

ZIP Code:

Phone:

Student Level of Academic Success (10 points possible)

Student GPA (4 points)

Credit Hours Completed (6 points)

Student Involvement / ON-CAMPUS (10 points possible)

On-Campus Activities (3 points):

On-Campus Leadership (2 points):

On-Campus Employment (1 points):

On-Campus Volunteerism (2 points):

On-Campus Honors & Awards (2 points):

Student Involvement / OFF-CAMPUS (10 points possible)

Off-Campus Activities (3 points):

Off-Campus Leadership (3 points):

Off-Campus Volunteerism (2 points):

Off-Campus Honors & Awards (2 points):

Service to Northwest by Student's Family (20 Points Possible)

Family members’ name & age (Please specify family members who are enrolled at Northwest or are alumni of Northwest):

On-Campus Activities as a Northwest Student (10 points possible)

Northwest Activities as a student (3 points):

Northwest Leadership as a student (3 points):

Northwest Volunteerism as a student (2 points):

Northwest Honors & Awards as a student (2 points):

Current University Involvement (10 points possible)

Attend Northwest Alumni Association activities (2 points):

Active within a Northwest academic school or college (2 points):

Attends Northwest campus events (2 points):

Volunteerism on campus (2 points):

Donor to Northwest (2 points):