SIGMA CHI CANADIAN FOUNDATION JIM GRIMES BROTHERHOOD AWARD APPLICATION FORM

This application must be completed by the Chapter Advisor of the nominee's home chapter, with a second by the active consul. Once complete submit the form by e-mail to Brother Malcolm MacLeod at mmacleod (at) idirect (dot) com.

Chapter Advisor’s Name: (required)

Chapter and University: (required)

Email: (required)

Cell Phone: (required)

Nominee’s Full Name: (required)

Chapter and University: (required)

Program: (required)

Permanent Email: (required)

Permanent Mailing Address: (required)

S.I.N.: (required)

Chapter & Expected Year of Graduation: (required)

Cell Phone: (required)

Describe how the nominee exemplifies the Sigma Chi Creed: (required)

Provide three examples of how the nominee has contributed to the Fraternity:

1.

2.

3.

Please provide the names of 2 other candidates that were given due consideration for this award: (required)

1.

2.

Consul’s Support

Consuls Name: (required)

Cell Phone: (required)

Consul’s second of this nomination by email (copy and paste) or affidavit from Chapter Advisor: (required)

Attestation Statement:

As Chapter Advisor and nominator of this award, I hereby support this nomination after having duly considered at least 3 active chapter members from the nominee’s chapter. By submitting this form, it will serve as my signature for this award.

Name: (required)

Chapter: (required)

Date: (required)

Comments: (required)

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