The Service Tradition of TC3

Please print this form, complete it and return to:

TC3 Foundation
P. O. Box 139
Dryden, NY 13053

Date: ______________

Name:
Address: (if available)
Home Phone: (if available)

Please check one:

__ High School Senior
__Current TC3 student
__Potential TC3 applicant

(Please check all that apply)

__ Academic Standing
__Work Ethic
__Community Service

Additional Comments:

Please indicate how you think the student is qualified in the appropriate area, taking as much space as you need - please use the back of this form for additional comments:
 

 

 

Academic Performance:

Name of Current Employer and Comments about Work Performance:

Service to the Community - Name of Agency, Service Performed:

May we let the student know that you were his/her nominator?

__Yes
__No
 

 

_______________________________
Signature of Nominator

_______________________________
Phone Number, days