Reporting Award Winners

Please provide the following information for each award winner. Submit the information by e-mail or on a floppy disk in Word or Word Perfect format. An electronic copy of this form can be e-mailed to you. Contact John.hanft@thomson.com

Date: _______________

School name and address:

_________________________________________

Form submitted by:

Name: ___________________________________

Phone: ___________________________________

e-mail: ___________________________________

________________________________________________________________________________________________

Provide the following information for each award winner. Please use the following chart, if possible. Please do not use all caps. Please list the names as they will appear on the certificate, with first name, middle initial, last name.

Student Name: Course Title: Term or Semester:

1. _______________________ _____________________ _______________________

2. _______________________ _____________________ _______________________

3. _______________________ _____________________ _______________________

4. _______________________ _____________________ _______________________

5. _______________________ _____________________ _______________________

6. _______________________ _____________________ _______________________

7. _______________________ _____________________ _______________________

8. _______________________ _____________________ _______________________