2019 Tri-State TRIO Achiever Nomination Form
Please read the following instructions carefully.

Nomination Due Date: Friday, March 1, 2019

Awards Dinner Date: Monday, April 8, 2019

The 2019 Tri-State TRIO Achiever award allows each Chapter TRIO Association to recognize outstanding TRIO alum who have achieved a high level of success in their current field of work or study. Nominees must have attained an A.A., A.S., B.A., B.S., M.A., M.S., or terminal degree within their field. The 2019 Tri-State TRIO Achievers are individuals who have overcome obstacles to achieve success and acknowledges that TRIO has supported their success.

1. Must have participated in and successfully completed one of the federally funded TRIO programs that are located in the state.

2. Must have enrolled in and successfully completed a post-secondary program of study resulting in an associates, baccalaureate, graduate, or terminal degree from an accredited institution of higher education.

3. Must hold a significant position within their profession or have received recognition for outstanding professional or academic achievement and be employed above the entry-level designation for his or her profession at the time of application.

4. Must have made significant civic, community, or professional contributions to TRIO or their local community by resume. Nominator must submit after online application completed.

5. Must demonstrate that participation in their TRIO project had a significant impact upon obtaining their educational and/or professional objectives by written essay. Nominator must submit after online application completed.

6. Willing to present a 10-minute address to the Tri-State TRIO membership during the TRIO Achievers Award dinner at the 2019 Tri-State TRIO Annual Conference in La Crosse, WI if selected for recognition (Most travel expenses will be provided for the winner).

Each Nominator for a 2019 Tri State TRIO Achiever must:
1. Complete, in its entirety, this official application form which includes submitting via email nominees statement essay and resume. Submit entire application online by March 1, 2019. Only online applications will be accepted.

2. Include a photograph for reproduction in the TRIO Achiever Awards dinner program booklet. (To be sent after notification of award)

3. Willing to introduce the winner at the 2019 TRIO Achiever dinner at the annual conference in La Crosse, WI.

4. The Nominator must be a current member of Iowa, Minnesota, or Wisconsin Chapters.

5. Nominators may choose to nominate a TRIO Achiever.

6. Nominator must submit nominees resume and essay by the March 1st deadline.

Questions? Please contact TRIO Achiever Award Lunch Chairs, Tricia Wilkinson, wilk0151@umn.edu,
(612) 625-3369 or Vanessa Beckham, beckhamv@beloit.edu, (608) 346-5797.

Thank you in advance for helping make our 2019 Awards dinner a success!

Nominator Information
The following questions are about you as the nominator.
Which Chapter are you a member of? *
Your Name *
Your answer
Title *
Your answer
Institution *
Your answer
Mailing Address *
Your answer
E-mail Address *
Your answer
Phone Number *
Your answer
Please write a statement about why this TRIO participant should be chosen as a TRIO Achiever. Please include: the impact TRIO had on the nominee, the nominee's impact on their community, perseverance and/or resilience in attaining their degree, determination in overcoming obstacles, current work/educational achievements, and future goals. *
Your answer
TRIO Achiever Nominee
The following questions are about the TRIO Achiever Nominee.
Nominee's Name *
Your answer
How many TRIO Programs did nominee participate in? *
Program/s Nominee Participated *
TRIO program participation dates *
Your answer
Institution where nominee participated in TRIO *
Your answer
TRIO Eligibility *
Education (Please list all institutions, degrees earned, subjects studied, and year(s) degree(s) were attained) *
Your answer
Employment (Please list title, employer, and dates of employment) *
Your answer
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