Leadership and Service Awards – 2016 Application
Mr./Mrs./Ms.
Local Address:
City:
_________
Student V #:
State:
☐ - Undergraduate
☐ - Graduate
School:
Major:
Have you attended another college/university?
Anticipated Graduation date:
Zip:
Phone:
☐ - Professional
Class:
GPA:
When did you enroll at VCU?
(semester/year)
Hours completed towards degree:
(month/year)
Email:
Award Application (if nominated for multiple awards, you must submit an application for each award)
□ Alumni Award - This award is presented to a Monroe Park Campus undergraduate senior who has exhibited
exemplary characteristics in the areas of scholastics, leadership and service to VCU and the Richmond community.
Recognition:
$500 monetary award
□ Dr. Henry G. Rhone Excellence in Student Affairs Award - Presented to undergraduate and
graduate/professional students who have provided distinguished service to the Division of Student Affairs and/or
the university.
Recognition:
$300 Scholarship
□ University Leadership Award - Presented to undergraduate and graduate/professional students in leadership
roles in student organizations or University committees who have distinguished themselves by demonstrating
outstanding leadership ability and commitment to their organizations.
Recognition:
A recognition certificate
□ University Service Award - Presented to undergraduate and graduate/professional students who have provided
outstanding service and commitment to university committees, student organizations and/or the Richmond
community.
Recognition:
A recognition certificate
□ Emerging Leader Award - Presented to undergraduate and graduate/professional students who have provided
distinguished service in their first leadership role(s) at VCU and demonstrated a potential for continued leadership.
Recognition:
A recognition certificate
Involvement:
Academic awards/honors including dates awards were received
Include scholarships, academic honor society memberships, and Dean’s List.
Non-Academic Awards
List any awards or honors you have received. Ex. Who’s Who, University Leadership and Service, etc.
VCU On-Campus Involvement
Include memberships in VCU student organizations and all positions held; VCU athletic team participation and all positions held; and,
University department affiliations. Please include dates of positions held, participation and affiliations.
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Off-Campus Involvement and Community Service
List any service/volunteer activities that you have performed for community agencies; i.e., churches, civic clubs, and political
organizations. Do not include activities which were/are requirements for membership in an organization, are/were for academic credit or
for which you are/were paid.
Application Supplements:
□ Resume: Include all relevant employment experience including work you may have done between semesters and internship
experiences.
□ Essays: Please submit your response to the following essay question (s). There is a different question for each award, so
please make sure that you submit the proper essay response for each award for which you are applying. No more than 300
words per essay.
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Alumni Award – What do you feel should be the role of alumni of Virginia Commonwealth University?
How do you plan to give back to VCU following your graduation?
Dr. Henry G. Rhone Excellence in Student Affairs Award – What do you consider to be your most
significant achievement to date in its value to your school or larger community? In what ways was it
important to others?
University Leadership Award – What is your personal definition of leadership? How have you been
able to implement that definition as a student at VCU?
University Service Award – Please share the most significant experience you have had involving a
service opportunity while at VCU. How did this experience change you as a result of your participation?
Emerging Leader Award – How do you plan to continue to grow and develop as a leader at VCU?
How can VCU better support emerging leaders in their leadership development?
□ Letter(s) of Reference
Please include a letter(s) of reference with each award you are applying. The letter of reference should be written by a person
who has knowledge of your contributions to the University Community or Richmond Community or who has personal
knowledge of your academic and co-curricular experiences. Choose someone who is able to write well about your
accomplishments in and out of the classroom.
Please have your reference letters sent directly to: Leadership and Service Awards Selection Committee, University Student
Commons, 907 Floyd Ave., Suite 104, P.O. Box 842032, Richmond, VA 23284-2032.
1. Name and Title of Reference:
E-mail:
Phone:
2. Name and Title of Reference:
E-mail:
Phone:
I give my permission to obtain access to my transcript and grades for verification purposes and release my
information to the Leadership and Service Awards Selection Committee.
Signature:
Date:
Return completed applications by 4 p.m. on Friday, March 4, 2016.
Submit by email to uscalsawards@vcu.edu or campus mail/hand deliver to:
Beverly A. Walker, Committee Chair
University Leadership and Service Awards
907 Floyd Avenue, Suite 104
PO Box 842032
Richmond, Virginia 23284-2035
FAX: 828-6182
Virginia Commonwealth University is an equal opportunity/affirmative action institution providing access to education and employment without regard to age, race, color, national origin, gender, religion,
sexual orientation, veteran’s status, political affiliation or disability. For special accommodations, please contact Beverly A. Walker at (804)828-6500.
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