Elbert W. Ockerman State & Regional Professional Activity Award Nomination Form

*Indicates required field

State or Regional Association Nominated *  

Title of Professional Activity (can be an outstanding program session, project, workshop or publication):*  

  
           Person Nominating this Activity

First Name *  
Last Name *  
Title *  
Institution *  
Address *  
Address (cont.)   
City *  
State *  
Zip *  
E-mail*  
Confirm E-mail *  
Phone *  


* Please describe the activity (including the history of the development, the intended audience, and how it was implemented):



* Describe how this activity benefited your state or regional association and its members:



If this activity is selected as a winner, a presentation will be given at the AACRAO Annual Meeting.
Please uncheck the box and enter the following information only if the presenter is different than the person submitting the nomination.


           Person Giving the Presentation

Presenter First Name  
Presenter Last Name  
Title  
Institution  
Address  
Address (cont.)   
City  
State  
Zip  
Phone  
E-mail  
Enter numbers as shown *  


SPECIAL NOTE: Also required is submission of a letter of support from the president of your state or regional association, as well as supporting documentation (e.g. agendas, promotional materials, handout publications, or summary results of session or conference evaluations).

These can be sent to Nancy Penna by email or mailed to:
Nancy S Penna
University Registrar
Capella University
225 South Sixth Street
Minneapolis, Minnesota 55406
Phone: (612) 977-5522
Fax: (612) 977-5055

Letter of Support