University of Mpumalanga Co-curricula Awards NOMINATION FORM 2023 How to nominate 1. Societies/Clubs/Teams can nominate individual candidates and /or societies/clubs/teams for the relevant/respective category. 2. Students can only nominate members of a society/club/residence, CRC/SRC, etc. 3. In a case of more than one nominations, a separate nomination form must be completed. 4. Incomplete forms will not be considered for assessment. Submit your completed form to: Office: Student Affairs Offices Mbombela Campus: Mrs Lebohang Sithole Student Development Officer 3rd Floor Building 10 West Wing, Email: Lebohang.Sithole@ump.ac.za Siyabuswa Campus: Mrs Euphodia Mashego Ground Floor Admin Building Email: Euphodia.Mashego@ump.ac.za Closing date for nominations 12 October 2023; 16h00 Nominee details (Complete where applicable, i.e. an individual or group nominee) Individual Nominee First name: Nominee student number: Nominee’s phone number: Nominee year of study: Surname: Nominee’s field of study: Name of Category: Campus: Group Name: Campus: Name of Category: Supporting documents When making your nomination, please provide short statements describing how the nominee meets the identified criteria, as per the attached criteria for the categories. Where possible, provide examples to support the statements. (Please limit response to space provided, and you may attach supporting documents to the form). 1. State the criteria: .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..………………….… 2. State the criteria: . .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..………………….… 3. State the criteria: .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… 4. State the criteria: .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… 5. State the criteria: .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… 6. State the criteria: .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… 7. State the criteria: .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… 8. State the criteria: .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… 9. State the criteria: .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… 10. State the criteria: .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… .…………………………………………………………………………………………………..………………….… .…………………………………………………………………………………………………..…………….……… Nominated by Name of the individual/team/society/club Student or Employee Number Signature Date