THE BACCHUS NETWORK AREA 6 CONFERENCE
University of Central Oklahoma
FEBRUARY 22-23, 2007
Please type or print legibly: (Conference Attendance is Not Necessary to Win Awards)
ORGANIZATION INFORMATION:
School Name___________________________Person Filing Nomination
Network Affiliate Name
Membership Size _______________________
CONTACT INFORMATION:
Advisor Name ________________________________________________________________________
Daytime Phone ( ) Fax Number ( )
Mailing Address
City, State, Zip
E-mail _______________________________________________________________________________
AWARD NOMINATION FROM: (please check all that apply)
( ) Outstanding Advisor
Nominee :_____________________________
Years of Service:_______________Years____________Months ______
Years as Advisor:_______________Years____________Months _____
( ) Outstanding Network Affiliate
( ) Outstanding Program (1 day event)
( ) Outstanding Peer Educator
Nominee:_________________________________________________________
Years of Service:________________________Years__________Months ______
( ) Outstanding Alumni
Nominee:_________________________________________________________
Years of Service:________________________Years__________Months ______
Please submit a two page, double spaced statement describing each Affiliate, Student, Advisor, or Alumni being nominated.
THE DEADLINE FOR AWARDS NOMINATION FORM IS
MONDAY, FEBRUARY 4, 2008.
Applications received after the deadline will not be considered.
Please submit award nomination forms to:
Kimberly Harvey-Livingston, MS, LPC
3900 University Blvd
Tyler, Tx 75799
Fax # (903)566-7242
Phone# (903)566-7197
e-mail: Kim_Harvey-Livingston@mail.uttyl.edu