Scholastic Achievement Award Recipient's Questionnaire

In addition to just your name being announced at the award ceremony, the Student Excellence Awards Committee would like to share any of the additional information that you indicate in this questionnaire. Please note that the information may be edited for brevity. IMPORTANT: If this questionnaire is not returned by Monday, March 24, 2008, please be aware that only your name will be called during the ceremony with no other personal information provided.

Please Check:    Mr.Ms.

 Your Name:
Your Phone Number:
(should we need to contact


 Email Address:
(should we need to contact you )
 My PJC degree is in:

My major area of emphasis will be:

If you are continuing your education, to
which college or university do you plan to attend?
My career / future plans are:
I am a member of the following Honor Organizations (please check):

Alpha Beta Gamma - Business
Alpha Mu Gamma - Foreign Language
Beta Phi Gamma - Journalism
Mu Alpha Theta - Mathematics
Phi Rho Pi - Debate/Forensics
Other / please specify:
Phi Theta Kappa - General Academic
PJC Robinson Honors- General Academic
Psi Beta - Psychology
Sigma Delta Mu - Spanish
Sigma Phi Alpha - Dental Hygiene
Indicate which, if any, leadership position(s) (for example: president, vice president, secretary,
treasurer) you hold/held in any of the above Honor Organizations:

Leadership Position:


 Organization:
Briefly state any other information pertinent to your educational progress (i.e., recognition, former dual-enrollment student, first generation college student, club membership or officer positions, scholarship, extra- curricular activities, etc.) :


 

If you have questions, please email or call Dr. Georgieanna Bryant, Administrative Liaison for the Student Excellence Awards Committee (850) 484-4440.

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