Vorschlag für den „Preis für studentisches Engagement“ Ich möchte folgende Person für den Einzelpreis vorschlagen: Vorname, Name: ____________________________________________________________________ E-Mail-Adresse: ____________________________________________________________________ Studiengang: ____________________________________________________________________ Begründung der Nominierung: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ und/oder 1 Ich möchte folgende Fachschaft/Arbeitskreis des Konvents/studentischen Verein etc. für den Gruppenpreis vorschlagen: _________________________________________________________________________________________ Begründung der Nominierung: _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ _________________________________________________________________________________________ Angaben zur/zum Vorschlagenden: Vorname, Name: ____________________________________________________________________ Fakultät/Abteilung: ____________________________________________________________________ E-Mail-Adresse: ____________________________________________________________________ Telefonnummer: ____________________________________________________________________ Bitte senden Sie das ausgefüllte Formular per E-Mail bis spätestens 16. Mai 2016 an: [email protected] 2