Program OTM Nomination Form

Date: Category: School:
September 2010

Nominee: Nominator:
Nominee Email: Nominator Email:

Program Title:
Target Population (In Numbers): Time Needed To Organize:
Number of People in Attendance: Date(s) of Program:
Number of People Needed to Organize: Cost of Program:

Origin of Program:


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Short Description of Program:


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Goals of Program:


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Positive and Lasting Effects of Program:


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Short Evaluation of Program:


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How could this program be adapted to other campuses?


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Please provide a short (3-4 sentence) summary of this OTM:


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