LAURIE JACK AWARD APPLICATION FORM Laurie Jack was President of the BCIT Student Association (BCITSA) in 1971-1972. Tragically, he died in an airplane crash in 1975. Together, his parents and the BCITSA have sponsored two $500 annual awards in his honour. These awards are given to two students in the final year of their program who have contributed to student life at BCIT and have been nominated by another BCIT community member (staff, faculty, or student). The selection of the two recipients is based on the following:
The student nominee must be a registered full-time BCIT student and graduating from a fulltime Technology or Trade program, taking part in Convocation in June 2012.
The student nominee must be someone who has contributed to and enhanced student life at BCIT. Student nominees may have demonstrated their contribution to areas including but not limited to: advocacy, student government, student clubs, campus life, resident life, leadership, and intramurals.
If you would like to nominate a student:
Fill out and sign the “Nominator” portion of this application; the remainder of the application is to be filled out by the Nominee.
The Nominee will attach a one page description of them self to this application, detailing their contribution to student life at BCIT and providing two supporting letters of reference from students, faculty, or staff within the BCIT campus community. Nominee’s Application – Laurie Jack Award
Name of Nominee (last, first)
Student Number
Program
Date of Graduation
Telephone - Home
Mobile
Address
3700 Willingdon Avenue, Burnaby BC, V5G 3H2 | Bus: 604.432.8600 Fax: 604.434.3809 | www.bcitsa.ca
Nominator’s Information
Name of Nominator (last, first)
Occupation
Relationship to Nominee
If you are a BCIT Student, which program?
Telephone - Home
Mobile
Address
Nominee’s Declaration
By signing this Declaration, I acknowledge that I am aware of my nomination for this award and that all information presented for review is complete and accurate. _________________________________________ Signature of Nominator
______________________________________ Date of Application
Nominator’s Declaration
By signing this Declaration, I acknowledge that I am nominating _______________________________ (Nominee’s Name) for this award and that all information presented for review is complete and accurate.
Signature of Nominator
Date of Application
Application forms are accepted at the Uconnect Resource Centre in SE2 at the Burnaby campus or by email at uconnect@bcitsa.ca. APPLICATION DEADLINE: Monday, April 30, 2012 at 4:00 pm Applications will not be accepted after the deadline.
All decisions are final and cannot be appealed.
3700 Willingdon Avenue, Burnaby BC, V5G 3H2 | Bus: 604.432.8600 Fax: 604.434.3809 | www.bcitsa.ca