Gerry and Bob Virgil Ethic of Service Award

NOMINATION FORM

Submission Deadline is February 5, 2010 at 5:00 p.m.

* All fields required unless otherwise noted *
NOMINATOR INFORMATION Please note: If your nominee is selected to receive the Gerry and Bob Virgil Ethic of Service Award, you will be asked to assist in drafting a brief biography of your nominee for the award program and website.
First Name:
Last Name:
Campus Mail Address	Campus Box:
Off-Campus Mail Address: *not required if you entered a campus mail address above	Street City State Zip
Email Address:
Phone:
Relationship to WU:	Student(Undergraduate) Student(Graduate/Professional) Faculty Staff Alumnus/a Retiree Friend
Please specify your affiliation(s) with WU (school, department, organization, etc.).
Additional nominators (please list the name, email address, mailing address, and WU affiliation of other individuals who are co-writing this nomination) *not required if you are the sole nominator

NOMINEE INFORMATION
First Name:
Last Name:
Campus Mail Address:	Campus Box
Mailing Address: *not required if you entered a campus mail address above	Street City State Zip
Email Address:
Phone:
Relationship to WU:	Student(Undergraduate) Student(Graduate/Professional) Faculty Staff Alumnus/a Retiree Friend
Please specify the nominee's affiliation(s) with WU (school, department, organization, etc.). For student nominees, please include school/major and class year. For staff/faculty/retiree nominees, please include job title. For alumni nominees, please include school/major and graduation year.
Is this a new or repeat nomination?	New Repeat (Repeat nominations must include a new submission form and updated description of nominee)

DESCRIPTION OF NOMINEE In the following box, please either answer the following questions about the nominee one at a time, or insert a letter that you feel addresses these questions. Complete nominations which paint a full picture of a nominee's qualifications for the award are strongly recommended. The nomination you submit will be the only information available to the selection committee about your nominee. How long have you known the nominee, and in what capacity? Why are you nominating this person for the Ethic of Service Award? How is the nominee involved in service to the St. Louis community that goes above and beyond professional responsibilities? Based on the list of characteristics below, which apply to the nominee and why? Please provide examples of how your nominee meets the criteria. Please note that your entry must be in plain text

CHARACTERISTICS OF AWARD HONOREES The award committee anticipates a broad range of nominations that define service to community in many different ways. While the committee is not looking for a specific type of community involvement, characteristics of award honorees might include one or more of the following: Considers service to the community to be a way of life Goes above and beyond professional responsibilities in their service to St. Louis Dedicated to serving others Creates impact on community issues of concern Demonstrates selflessness Positively influences people’s perceptions of St. Louis Believes in the St. Louis region Inspires compassion and action in others; Shows compassion for others Exudes passion for a social, cultural, or economic issue
Please include a list of individuals (name, email address, mailing address) who should be notified if the nominee receives the Gerry and Bob Virgil Ethic of Service Award) *not required

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