Student Recognition Form

This form is intended to collect information on student accomplishments.  Please be as thorough as possible and any additional information you would like to include can be emailed to coph@unmc.edu.

Thank you!!

 

[contact-form to=’coph@unmc.edu’ subject=’Student Recognition’][contact-field label=’Student First and Last Name’ type=’name’ required=’1’/][contact-field label=’Public Health Program’ type=’text’ required=’1’/][contact-field label=’Advisor Name’ type=’text’ required=’1’/][contact-field label=’Type of Recognition’ type=’select’ required=’1′ options=’Scholarship,Award,Presentation,Fellowship,Internship,Other’/][contact-field label=’Other Recognition- Please Describe’ type=’textarea’/][contact-field label=’Name/Title of Recognition: ‘ type=’text’ required=’1’/][contact-field label=’Date/Expected Date of Recognition: ‘ type=’text’/][contact-field label=’Organization Awarding the Recognition: ‘ type=’textarea’/][contact-field label=’Collaborators in the Recognition (Faculty, Students, Staff, Community Member, Etc.)’ type=’textarea’/][contact-field label=’Description of the Recognition ‘ type=’textarea’/][contact-field label=’Why Recognition was Received’ type=’textarea’/][/contact-form]

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