Presidential Scholar Awardee Information Form

Faculty Senate

Today's Date (required)

Name (required)

First name

Last name

Department (required)

Student's Western Identification Number (WIN) (required)

Your nine-digit 51�� Identification Number.

E-Mail Address (required)

Mailing Address (please include street, city, state, zip) (required)

Anticipated graduation date (required)

List your major of study at 51�� (noting any concentration, option, etc.) (required)

Are you are a recipient of a full (4-year) Medallion Scholarship? (required)

Yes

Are you a member of the Lee Honors College? (required)

Yes

Where do you consider your hometown, along with city/state?

Name and city of the high school you graduated from

List other higher education institution(s), along with city/state, you graduated from and degree(s) earned

Confirm your attendance at the in-person event (required)

Yes

Name of Guest-1

Name of Guest-2

Name of Faculty Guest