CALS Alumni Association
Richard A. Church ’64 Senior Service Award
Application Form
Name:
Email:
Ithaca Address:
Telephone:
Hometown:
Major:
1. What contributions have you made to the College of Agriculture and Life Sciences?
Organizations
Years
Leaderships Positions
Responsibilities and Results
2. What contributions have you made to the University?
Organizations
Years
Leaderships Positions
Responsibilities and Results
3. What paid work within the College or University and/or Teaching Assistant (paid or credited) positions have you
held?
Organizations
4.
Years
Responsibilities
What do you consider to be your greatest achievement at Cornell (use additional pages if needed)?
Please include a letter of reference from a faculty advisor, organization advisor or supervisor and a
resume.