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Student Leader Nomination Form

Note: This form should be submitted by the training program's Faculty Sponsor. We are currently accepting 2008-09 Student Leader nominations for a one-year term starting on July 1, 2008.

Name:

University:

Mailing Address 1:

Mailing Address 2:

City:

State:

Zip Code:

E-mail:

Daytime Phone:

Degree program in 2008-2009: Masters
Specialist
Doctorate

Year in the program in 2008-2009: 12345

Is this student a current NASP student member? (NASP student membership is required.) YesNo

Is your program NASP approved? YesNo

Does your program have a local student organization? YesNo

Number of students in your program:

Faculty Sponsor

Name:

Mailing Address 1:

Mailing Address 2:

City:

State:

Zip Code:

E-mail:

Daytime Phone: