Check all that apply:

• Fanie Lou Hamer Community Service Award
• Dr. Martin Luther King, Jr. Leadership Award
• Nguzo Saba Award for Excellence in Scholarship, Leadership and Service
• The Edward Mitchell Award
• Distinguished Service Award
• Althea Gibson Award for Athletic Achievement
• Jesse Owens Award for Athletic Achievement
• Lorraine Hansberry and James Van Der Zee Awards for Performing Arts
• Lorraine Hansberry and James Van Der Zee Awards for Fine Arts

Nominee*

Hinman Box*

Major(s)

Minor(s)

Academic Year* Select One... Freshman Sophomore Junior Senior / coterm / 5th+ year Graduate

Please list two members of the Dartmouth community (students, staff or faculty) who are familiar with this student's work:

Nominator

Department/Class Year*

Hinman Box*

How do you know the nominee?*

• Personal Integrity and Strong Personal Character
  
• Leadership
  
• Scholarship/Academic Initiative
  
• Community Engagement/Community Service
  
• Commitment to the Enhancement of the Black Student Experience
  
• Special Achievements/Additional Information
  

For Performing/Fine Arts and Athletic Awards, please outline accomplishments here: