RANDOLPH.

MACON COLLEGE LEADERSHIP AWARD PROGRAM

Recipient Information tr'orm
Secondary School Name

Primary contact for Leadership Award

Phone Number/Email Address:

Secondary SchoolAddress (This address

will

be used for shipping/mailing purposes.)

We have verified that our R-MC Leadership Award recipient has met the following criteria:
a

The recipient should be an excellent student scholastically (B+ average or above; top Y+of the class), and be

enrolled in a solid college preparatory program.

a

The recipient should be a well-rounded individual who excels in the classroom and is also an active
participant in extracurricular activities (in school, church, or the community), especially in leadership roles.
Preference should be given to those with significant student council experience or those who achievedlare
achieving their Gold Award or Eagle Scout Rank.
The recipient should have completed a minimum of 20 hours of community service.

Our Randolph-Macon Iadership Award recipient is: (Please print clearly.)

Student's Name: (First, Middle, Last)
Preferred Name

Home Address:

EmailAddress:

CumulativeGPA

Rank in Class

SAT or ACT Scores

Number of Community Service Hours Completed primary focus of services:

Leadership position(s) in extracurricular activities and years served:

Brief description of recipient's academic areas of special achievemenSonors, awards, and extracurricular participation

Our School's Honors/Awards Assembly

Date:

will

be held:

amlpm) Location:

Time:

Would you like to havean R-MC representative (if available) present the award at your assembly? Yes/.{o

tDue to the nature of this award all recipients must receive their award by the close of their junior year. We are unable to
accommodate award ceremonies that take place in the fall of the senior year.

Return this form by Friday, May

Olivia McGuckin
Assistant Director of Admissions
Randolph-Macon College
PO BOX 5005
Ashland, VA 23005
Email : oliviamcguckin@rmc.edu
Phone: 804-752-3206
Fax: 804-752-4707

1 2015

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