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Lt. Governor > Recognitions & Awards > Hoosier Rising Star Award > Award Nomination Application Award Nomination Application

Please complete this form by March 2, 2012. All fields and questions must be complete in order for the nominee to be considered for the Hoosier Rising Star Award.

Part A: Nominator's Information

Name:

Address:

City:

State:

Zip Code:

Phone Number:

Email Address:

Section B: Student's Information

Applicant's Name:

Address:

City:

State:

Zip Code:

Phone Number:

Email Address:

Student's Age:

Name of current school student is attending:

Section C:

Why does this student deserve the Hoosier Rising Star Award?


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Please list the nominee’s activities or service to their community.


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Please explain the nominee's impact on their community.


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Nominations may be supplemented by the student’s biography, up to three letters of recommendation, and any relevant press clippings. All application materials must be received by March 2, 2012.

Will additional materials be submitted?

* Please send additional Hoosier Rising Star materials (bio, letters of recommendation and press clippings) either through mail or email to:
Amy Lore
Lt. Governor Becky Skillman’s Office
200 West Washington Street, Room 333
Indianapolis, IN 46204
alore@lg.in.gov

*Please contact Amy Lore at alore@lg.in.gov or 317.431.1884 with any questions regarding the Lt. Gov.’s Hoosier Rising Star Award.

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