2023 Robert J. Tiffin Student Leadership Award - Nomination Form

This award recognizes students whose leadership has contributed to the growth, development, and vitality of York University.

The nomination deadline is midnight on Monday, March 13, 2023 (Eastern Standard Time).

We kindly ask you to review and compile all the application requirements before submitting.

Please submit your form only once and identify if you are the student, primary nominator, or a secondary nominator under the “Are you?” section. Only submit for the role that applies to you.

Please email vpstudents@yorku.ca if you have any questions.

____________________________________________________

Are you? *

Are you? Primary Nominator Secondary Nominator Student
Primary Nominator
(Only one primary nominator submission accepted)
Name Name * First Last
Email *
As the nominator, please indicate your affiliation with the university and the capacity in which you are supporting this nomination. *
Name of Nominated Student Name of Nominated Student * First Last
SISID / Student Number *
How do you know the student, and for how long, have you known the student? (up to 50 words). *
Maximum of 50 words allowed. Currently Entered: 0 words.

On a scale of 1 to 5, with 5 being the highest (e.g. exceptional, outstanding), please rate the student based on the following: *
	1	2	3	4	5
1. Ability to lead and engage others	1. Ability to lead and engage others1	1. Ability to lead and engage others2	1. Ability to lead and engage others3	1. Ability to lead and engage others4	1. Ability to lead and engage others5
2. Dedication to making York a better place	2. Dedication to making York a better place1	2. Dedication to making York a better place2	2. Dedication to making York a better place3	2. Dedication to making York a better place4	2. Dedication to making York a better place5
3. Honesty and integrity in working with others	3. Honesty and integrity in working with others1	3. Honesty and integrity in working with others2	3. Honesty and integrity in working with others3	3. Honesty and integrity in working with others4	3. Honesty and integrity in working with others5
4. Enthusiasm and positive outlook	4. Enthusiasm and positive outlook1	4. Enthusiasm and positive outlook2	4. Enthusiasm and positive outlook3	4. Enthusiasm and positive outlook4	4. Enthusiasm and positive outlook5
5. Commitment to excellence	5. Commitment to excellence1	5. Commitment to excellence2	5. Commitment to excellence3	5. Commitment to excellence4	5. Commitment to excellence5

The student’s voluntary contribution(s) may be in one or several areas. The student’s overall contribution and how they approached their volunteer role(s) should be considered, rather than the office or title held. Please indicate where you have direct knowledge of the student’s volunteer contribution(s) (do not include paid positions, check all that apply): *

The student’s voluntary contribution(s) may be in one or several areas. The student’s overall contribution and how they approached their volunteer role(s) should be considered, rather than the office or title held. Please indicate where you have direct knowledge of the student’s volunteer contribution(s) (do not include paid positions, check all that apply): Leadership on committees, campus groups or organizations Active involvement on academic committees and councils Contribution to improving the quality of life of students (including specific student communities) Encouragement of other students to get involved General contribution to the York University community
Please include below why you feel the student should receive the Robert J. Tiffin Leadership Award.

Please outline the unique skills and attributes that the student demonstrated in their volunteer role(s) and the impact of their contribution(s).

Up to 500 words. *
Maximum of 500 words allowed. Currently Entered: 0 words.
Secondary Nominator
(Only one secondary nominator submission accepted)
Name Name * First Last
Email *
As the nominator, please indicate your affiliation with the university and the capacity in which you are supporting this nomination. *
Name of Nominated Student Name of Nominated Student * First Last
SISID / Student Number *
How do you know the student, and for how long, have you known the student? (up to 50 words). *
Maximum of 50 words allowed. Currently Entered: 0 words.

On a scale of 1 to 5, with 5 being the highest (e.g. exceptional, outstanding), please rate the student based on the following: *
	1	2	3	4	5
1. Ability to lead and engage others	1. Ability to lead and engage others1	1. Ability to lead and engage others2	1. Ability to lead and engage others3	1. Ability to lead and engage others4	1. Ability to lead and engage others5
2. Dedication to making York a better place	2. Dedication to making York a better place1	2. Dedication to making York a better place2	2. Dedication to making York a better place3	2. Dedication to making York a better place4	2. Dedication to making York a better place5
3. Honesty and integrity in working with others	3. Honesty and integrity in working with others1	3. Honesty and integrity in working with others2	3. Honesty and integrity in working with others3	3. Honesty and integrity in working with others4	3. Honesty and integrity in working with others5
4. Enthusiasm and positive outlook	4. Enthusiasm and positive outlook1	4. Enthusiasm and positive outlook2	4. Enthusiasm and positive outlook3	4. Enthusiasm and positive outlook4	4. Enthusiasm and positive outlook5
5. Commitment to excellence	5. Commitment to excellence1	5. Commitment to excellence2	5. Commitment to excellence3	5. Commitment to excellence4	5. Commitment to excellence5

The student’s voluntary contribution(s) may be in one or several areas. The student’s overall contribution and how they approached their volunteer role(s) should be considered, rather than the office or title held. Please indicate where you have direct knowledge of the student’s volunteer contribution(s) (do not include paid positions, check all that apply): *

The student’s voluntary contribution(s) may be in one or several areas. The student’s overall contribution and how they approached their volunteer role(s) should be considered, rather than the office or title held. Please indicate where you have direct knowledge of the student’s volunteer contribution(s) (do not include paid positions, check all that apply): Leadership on committees, campus groups or organizations Active involvement on academic committees and councils Contribution to improving the quality of life of students (including specific student communities) Encouragement of other students to get involved General contribution to the York University community
Please include below why you feel the student should receive the Robert J. Tiffin Leadership Award.

Please outline the unique skills and attributes that the student demonstrated in their volunteer role(s) and the impact of their contribution(s).

Up to 350 words. *
Maximum of 350 words allowed. Currently Entered: 0 words.
Student
Name

If you are selected as a recipient, this is the name that will appear on your certificate and permanently on the awards display in the Vari Hall Rotunda. Please ensure spelling is correct. *
Email *
SISID / Student Number *
I am a *

I am a Undergraduate Student Graduate Student
Faculty *

Faculty School of the Arts, Media, Performance & Design Faculty of Education Faculty of Environmental and Urban Change Glendon Faculty of Health Lassonde School of Engineering Faculty of Liberal Arts & Professional Studies Osgoode Hall Law School Schulich School of Business Faculty of Science Other Other
Address Address *
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Phone Number *
Your voluntary contribution(s) to the York community may be in one or several areas. Please indicate the area(s) that you have contributed as a volunteer, not including any paid positions. (check all that apply): *

Your voluntary contribution(s) to the York community may be in one or several areas. Please indicate the area(s) that you have contributed as a volunteer, not including any paid positions. (check all that apply): Leadership on committees, campus groups or organizations Active involvement on academic committees and councils Contribution to improving the quality of life of students (including specific student communities) Encouragement of other students to get involved General contribution to the York University community
Please provide information about your most significant volunteer contributions (up to three examples maximum). These should include examples where you feel you demonstrated strong leadership skills and contributed to the York community.

• Example 1: Role/Activity; start date (month/year); end date (month/year); briefly describe your contribution
• Example 2: Role/Activity; start date (month/year); end date (month/year); briefly describe your contribution
• Example 3: Role/Activity; start date (month/year); end date (month/year); briefly describe your contribution

Up to 125 words. *
Maximum of 125 words allowed. Currently Entered: 0 words.
Please describe your most impactful or meaningful voluntary contribution at York University. Why did you choose to get involved? How did it improve York and what did you gain from that experience (up to 125 words)? *
Maximum of 125 words allowed. Currently Entered: 0 words.
Please describe an experience as a volunteer, at York University, where you felt you really challenged yourself. What did you learn from that experience (up to 125 words)? *
Maximum of 125 words allowed. Currently Entered: 0 words.
Please share insights you have, through your voluntary roles, about what it means to be a good leader and/or to work towards positive change for the York community (up to 125 words). *
Maximum of 125 words allowed. Currently Entered: 0 words.
York University is committed to equity, diversity, inclusion, and Indigenization. If there is information that you would like the committee to have, for the purposes of reviewing your application, you are welcome to share information on a voluntary basis. Please note that a response to this question is optional (up to 50 words).
Maximum of 50 words allowed. Currently Entered: 0 words.
Resumé/CV: Please ensure your name is included in the document. *

Attach Files
Privacy and Data Collection

We care about your privacy. Personal information that you provide to the University is collected under the authority of the York University Act, 1965 and in accordance with Ontario's Freedom of Information and Protection of Privacy Act (FIPPA). It is used to process your application for the Robert J. Tiffin Student Leadership Award and for the purpose of statistical reporting to government agencies as required by law. At all times it will be protected in accordance with the Freedom of Information and Protection of Privacy Act (FIPPA) and is subject to York’s Common Record Schedule. If you have questions about the use and disclosure of this information, please contact the Office of the Vice-Provost, Students at vpstudents@yorku.ca.

2023 Robert J. Tiffin Student Leadership Award - Nomination Form

2023 Robert J. Tiffin Student Leadership Award - Nomination Form

Primary Nominator

Secondary Nominator

Student