WEISS PRESIDENTIAL FELLOWSHIP NOMINATIONS COMMITTEE STUDENT NOMINEE

Student Name _____________________________________________________________________

Address __________________________________________________________________________

E-mail Address ________________________________ Phone _____________________________

College __________________________________________________________________________

Major _____________________________________________________ GPA _________________

Area(s) of Interest ____________________________________________________________ _____

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Awards/Honors Received _________________________________________________ _________

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Extracurricular Activities ___________________________________________________________

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Have you ever been an Undergraduate Teaching Assistant for any course at Cornell and if so which course(s)?

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Students are encouraged to attach copies of their resumes.

PLEASE RETURN TO KAREN LUCAS, 315 DAY HALL, BY NOVEMBER 25, 2009