Presidential Scholar Selection Form

Faculty Senate

Tolday's Date (required)

College (required)

Department (required)

Department Representative's (required)

First name

Last name

Department Representative's email (required)

Department Support Staff's

First name

Last name:

Department Support Staff's email

Name of Student Selected (required)

First name

Last name

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

Your nine-digit 51�� Identification Number.

Student's email (required)