This is the NOMINATION form for The Peter G. Ruppert Scholarship which will be awarded to a graduating EGRHS Senior at the Awards Assembly in May.

This is NOT an application – students must be nominated by March 15 to be eligible for this award.

Thank you for taking the time to nominate a deserving student!

The Peter G. Ruppert Scholarship NOMINATION FORM

Date

Nominator Information

Name of person making the nomination:

(Self-nominations are not accepted for this award):

Nominator phone number:

Nominator email:

Nominee Information

Name of nominee (must be a current EGRHS Senior):

Nominee's Birth Date:

Nominee's Address

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Address Line 2

City

State / Province / Region

ZIP / Postal Code

Nominee's Phone

Nominee's Email

College nominee is planning to attend:

Nominee's parents names:

Nominee's parents home phone:

Nominee's parents other phone:

Briefly describe an example of how the nominee exemplifies the criteria listed on the award description page.

Please use the space below or a separate sheet of paper to briefly describe an example of how the nominee exemplifies the criteria listed on the award description page. (The box below will expand as you type):

Nominations must be received at the EGR Schools Foundation Office, 2915 Hall St. SE, Grand Rapids, MI 49506, no later than March 15.