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 Student ____________________________, _____________________________ Last name      First name  IIT LEADERSHIP ACADEMY  Scholarship  Faculty/Staff Nomination Form   This form should be completed by the faculty/staff member as supporting documentation for the student’s application for the IIT Leadership Academy full tuition scholarship.   Prior to completin g this form, faculty/staff should review the student’s scholarship application. Based on information contained in the student’s scholarship application as well as knowledge of the student’s work in class, research, etc., you should rate the student’s l eadership potential based on five key areas:   Academic Excellence Leadership Experience Career Goals and Drive Communication Skills Team Skills  These criteria should be rated on a 7-point scale that ranges from  1 = Clearly Below Expected, 4 = Expected, and 7 = Clearly Above Expected.  After you have rated each of the five criteria, you should also provide an overall rating of the student’s leadership potential.   Your ratings will be a key factor in determining finalists for the Leadership Academy scholarship.  You should forward all materials to:  Dr. Bruce Fisher, Leadership Academy Life Science Building 3105 South Dearborn Room 136  Please forward questions you may have regarding this form or process to 312.567.6474 or [email protected]  These forms must be received no later than Friday, February 11 th 2011.  Please be advised that your ratings are completely confidential and will not be shared with the student.      

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