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Home > Student Life > Student Support > Student Conduct > About Student Conduct > Chacivity Award

Office of Student Conduct

Chacivity Nomination Form

Please fill out the form below to nominate a student for the Chacivity Award. All fields are required, except as noted.

Nominee

Nominee’s First Name

Nominee’s Last Name

Nominee’s E-mail Address

Nominee’s Phone

Nominee’s Address Line 1

Nominee’s Address Line 2 (Optional)

Nominee’s City

Nominee’s
State

Nominee’s
Zip Code

Please describe why you believe the student deserves this award

Person Completing Nomination Form

First Name

Last Name

Title

Department/Office

Your E-mail Address

Phone

Office of Student Conduct
Center for Student Life
Pratt Hall, Room 307
201 Pratt Drive
Indiana, PA 15705
Phone: 724-357-1264
Fax: 724-357-1242

Office Hours
Monday - Friday
8:00 a.m. - 12:00 p.m.
1:00 p.m. - 4:30 p.m.

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