Program OTM Form
Month:
Year:
Category:
Nominee's School:
University of Virginia at Wise
Region:
SAACURH

Person in Charge:

 Nominator:
Address:


 Address:
Phone:

 Phone:
Email Address:

Email Address:
On Campus Population:
Chapter Size(NRHH):
Program Title:
Target Population (in numbers):
 Time Needed to Organize:
Number of People in Attendance
 Date(s) of Program:
Number of People Needed to Organize:
 Cost of Program:

 

Origin of program
Maximum Word Count: 200

 

Please give a short description of program
Maximum Word Count: 400

 

Goals of program
Maximum Word Count: 200

 

Positive and lasting effects of the program
Maximum Word Count: 200

 

Short evaluation of the program
Maximum Word Count: 200

 

How could this program be adapted to other campuses?
Maximum Word Count: 200

 

World Wide Web nominations must be typed on this form and must not exceed 600 words. Nominations not following this format may not be considered for a national award. No additional material will be considered. Nominations must be submitted by midnight on the 10th day of the month following the month of nomination.

Revised April 2005

 

 

 

Please give a short 3-4 sentence summary of this OTM.