1. Nomination Call for NAGE Role Model
We are pleased to announce a “Nomination Call for NAGE Role Model” at Lakehead
University.
The NAGE Role Model Program provides an opportunity for Aboriginal, Metis or Inuit
students to be recognized for their achievements, leadership and innovation.
Role models must be enrolled in full time studies in either the Masters or PHd program
at Lakehead University.
Two NAGE Role Models will be selected. One will be chosen from a Masters Program
and one will be selected from a PHd program. Winners will be announced on February
16th, 2012.
Who:
Anyone can nominate their role model by filling out the nomination form. Students may
nominate themselves.
When:
Nomination deadline is 12:00 PM on Friday, February 3, 2012.
How:
You can nominate a NAGE Role Model by submitting:
 Nomination form
Please send submit form to:
ABORIGINAL CULTURAL & SUPPORT SERVICES (ACSS)
Attention: NAGE Coordinator, Fay Zoccole
Regional Centre – 0002
955 Oliver Road
Thunder Bay, Ontario P7B 5E1
Phone: (807) 343-8085 FAX: (807) 346-7757
Email: fzoccole@lakeheadu.ca

2. NAGE Role Model Nomination Form
Part A: Nominator and Role Model Information
Nominator
Full Name: ___________________________________________________________
Address: _____________________________________________________________
_____________________________________________________________________
Phone: ______________________________ Email: _________________________
My NAGE Role Model
First Name: ___________________________ Last name: _____________________
Address: _____________________________________________________________
_____________________________________________________________________
Phone: ___________________________ Email: ____________________________
This student is registered in: (check one) Which course is this student taking?
 Masters Program __________________________________
 PhD Program Specialization: _____________________
Part B: Reason for Nomination
Provide details of the achievements of your nominee: (Please enter as much detail as
you can to help the judging panel):
1. Introduction: Tell us a bit about your Role Model
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
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3. 2. VOLUNTEER (e.g., Do they work for free at community events? What events and
how often do they volunteer? with Elders? What kind of things do they do? etc.)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
3. HELPFUL (e.g., Do they help others with their work? How do they help others? Do
they treat others with respect and care? etc.)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
4. OVERCOMING ADVERSITY (e.g., Have they lost family members or had setbacks
or challenges that they have had to overcome? Did they manage to move on with their
life in a positive way? How have they overcome their struggles? etc.)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
5. EXCELLENT STUDENT (e.g., What is their level of education? What program are
they taking? Do they work hard for good grades? What kind of academic awards have
they received? etc.)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
6. OTHER IMPACTS (e.g., What other areas have they impacted you or others? Have
they won awards? For what? How are they a role model? How do they contribute to
Lakehead University? etc.)
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
______________________________________________________________________
Please feel free to add an additional page to help the judges get to know your nominee better.