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2024 Boston University
Phi Theta Kappa Scholarship
Nomination Form

*Nominee's First Name:		*Nominee's Last Name:
Date of Birth:	(MM/DD/YYYY)

Address:
City:		State:		Zip Code:

Please support this nominee by providing a statement in the space below that includes your observations and an evaluation of the nominee’s academic ability, potential, character, and leadership qualities. All application and nomination materials should be submitted by March 1, 2024.

*Statement of Support:

*Evaluator Name:		*Institution:
*Evaluator Email:		*Position:
*Date:	(MM/DD/YYYY)

Boston University's policies provide for equal opportunity and affirmative action in employment and admission to all programs of the University.