STUDENT ACHIEVEMENT AWARD 2005

ENTRY FORM

1.       Name of Academic Institution

____________________________________________________________________________________________

2.       Name & contact address of person submitting entry ____________________________________________________________________________________________

____________________________________________________________________________________________

Tel No________________________________   Email : ________________________________________________

Status in relationship to student :  ___________________________________(tutor / course leader/ department head)

3.       Course Title   _________________________________________________________________________________

4.       Name of Student     _____________________________________________Student Year _____________________

5.       Brief  Description of Qualifying Qualities of Student ___________________________________________________________________________________________

___________________________________________________________________________________________

___________________________________________________________________________________________

6.       Brief Description of Student Achievement

(please  also supply full  resume of achievements on separate sheet if necessary)

      ____________________________________________________________________________________________

      ____________________________________________________________________________________________

      ____________________________________________________________________________________________

     ____________________________________________________________________________________________