Parent of the Year Nomination Form

Read about the 2010 Parents of the Year

Applications and essays must be received by September 25, 2011

in the Dean of Students Office ( University of Louisville, SAC W301E, Louisville, KY, 40292)

Student Name (Required)

Student E-Mail Address (Required)

Student Status

Please Select One

Student ID (Required)

Student Local Phone (Required)

Student Cell Phone (Required)

Student Address (Required)

Campus Post Office Box # - if applicable

Residence Hall and Room # - if applicable

Parent Information

Name of Parent(s) Being Nominated (Required)

Address of Parent(s) Being Nominated (Required)

Phone # of Parent(s) Being Nominated (Required)

EMAIL of Parent(s) Being Nominated (Required)

Please Tell Us Why Your Parent(s) Should Be The 2011 Parent Of The Year: (Required)

If your parent is selected may we read selections from your essay during the presentation:

Yes
No

If my nomination is selected, I grant permission for any photos taken during the award presentation to be used for future publicity for the Parent of the Year Award, and Family Weekend publications.

I understand that the University of Louisville may copy or duplicate my entry for future use in publications or other mediums for marketing purposes with no compensation to me.

Student Signature (Required)

Date

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Parent of the Year Nomination Form

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