---

Award for Outstanding Undergraduates
1999-2000 Nomination Form

Please send four copies of the nomination package to the postal address listed below.

CRA Undergraduate Award
Computing Research Association
1100 Seventeenth Street NW, Suite 507
Washington, DC 20036-4632

Please include a copy of following form with each of the four nomination packages.

Name of nominee:
Sex:
Social Security Number:
Program of study:
Year in program:
Department:
University:
Academic year address:

Permanent home address:

Academic year telephone:
Permanent telephone:
E-mail address:

Name of department chair:
Chair's e-mail address:
Name of first supporting nominator:
Supporting nominator's e-mail address:
Name of second supporting nominator:
Supporting nominator's e-mail address:

Signatures

Applicant:
date:

Department Chair:
date:

Supporting nominator:
date:

Supporting nominator:
date: