Ecological Society of America

SEEDS CHAPTER OF THE YEAR AWARD APPLICATION FOR CHAPTER NOMINATION

ALL INFORMATION REQUESTED IS REQUIRED.

General Information
Chapter Name:
Institution:
Primary Advisor:
Last Name First Name Middle Name
Title/Position:
Telephone Number:
Fax Number:
Email Address: (name@domain.com)
Mailing Address:
Department:
City:
State:
Zipcode:
Co-Advisor:
Last Name First Name Middle Name
Title/Position:
Email Address:
Telephone Number:
Fax Number:
Mailing Address:
Department:
City:
State:
Zipcode:
Student Representative
Student Name:
Last Name First Name Middle Name
Telephone No:
Email Address:
Alternate Telephone:
Alternate Email:
Campus Address:
City:
State:
Zipcode:
Permanent Address:
City:
State:
Zipcode:
Current Class Standing: Freshman Sophomore Junior Senior
Major:
Minor/Concentration:
Graduation Date (MM/YYYY):
Degree: (to be Obtained at Graduation)

Where did you learn about this opportunity? (select ONLY one ):

Direct email from ESA/SEEDS Other organization website/listserv/bulletin board
Web search Communication from a faculty/professor/advisor
Communication from a prior SEEDS participant SEED Chapter
I have participated with SEEDS before At A Conference/Meeting

General Members
Full Name Email Address Major Grad Year
Chapter Mission
Please describe the mission of your Chapter.
Why is your chapter deserving of the Chapter of the Year Award?
How does your Chapter demonstrate commitment to the mission and goals of SEEDS? (Through Education and Outreach, Recruitment, Research, and Career Development)
Biographical Sketch of Chapter
Please include history of chapter and its members, successes, hardships, etc
Chapter Certification

Application Completed by

Full Name:

I have read and checked this application for omissions and errors. To the best of my knowledge, the information in this application is complete and accurate. I understand that the inclusion of false information or the failure to provide all information requested in this application may disqualify our Chapter and its members from further opportunities with the Ecological Society of America's SEEDS Program.

As a SEEDS Campus Ecology Chapter, we will serve the mission of SEEDS - to promote ecology opportunities for students, particularly those underrepresented in the science, to stimulate and nurture their interest, in order to diversify and advance the field of ecology. To achieve this mission, we will welcome participation from underrepresented minority groups as well as others with a demonstrated commitment to these goals.

The Chapter Advisor, Co-Advisor, and Student Representative agree to the above: Yes No
Date: (mm/dd/yyyy)

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