Campus Being a Difference Award Form

Upon successful submission of the form, please allow 4 weeks for delivery.

Today's Date

mm/dd/yyyy

School Name

Name of Person Submitting this Form

StudentCPT Role

Email Address:

Date needed in hands

mm/dd/yyyy

Date to appear on certificate

mm/dd/yyyy

Mailing address to send certificates

Please include an accurate mailing address (name, mailbox number, street, city, state and zip). Failure to provide this information will delay shipping.

Student Nomination Criteria

*Only one student nomination per university/college

Nominees will be considered on the following criteria:

Is a student currently enrolled in classes on campus.
Has shown exemplary conduct with students, faculty and the community.
Has taken the lead or provided significant support to ethical practices or programs on campus.
Exhibits personal values and actions that demonstrate integrity and ethics.
Has faced a recent challenge and overcome it with integrity, or taken other recent steps to show commitment to ethics.
Has taken the lead or supported efforts emphasizing strong ethics and leadership development

Name of Student Honoree

Student Honoree Email Address

Student Honoree Classification

Academic Major of Student Honoree

How does the nominee display leadership on campus?

How has the nominee displayed ethical behavior?

Why is this nominee deserving of the Campus BADA?

Additional Info (Optional)

Faculty Nomination Criteria

*Only one faculty nomination per university/college

Nominees will be considered on the following criteria:

Holds any faculty position on campus.
Has shown exemplary conduct with students, faculty and the community.
Has taken the lead or provided significant support to ethical practices or programs on campus.
Exhibits personal values and actions that demonstrate integrity and ethics.
Has faced a recent challenge and overcome it with integrity, or taken other recent steps to show commitment to ethics.
Has taken the lead or supported efforts emphasizing strong ethics and leadership development

Name of Faculty Honoree

Faculty Honoree Email Address

Faculty Department Name

Courses taught by faculty (if any)

How does the nominee display leadership on campus

How has the nominee displayed ethical behavior?

Why does the nominee desrve this award?

Additional Information (Optional)

Attach Photos and/or Flyers

Please share as many photos you would like to include (optional)

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