EmailMe Form - Student Rep Nomination Form

Name *

First Last

Email *

This should be your @brunel.ac.uk email address

Student ID No. *

Type of Rep *

Course Rep

School Rep

Graduate School Rep

You may nominate yourself for both Course and School Rep should you wish

School *

Course Title *

2012-13 Level of Study *

Proposer Name *

First Last

A fellow student from your course/school who supports your nomination

Proposer Student ID No. *

Seconder Name *

First Last

A second fellow student from your course/school who supports your nomination

Seconder Student ID No. *

In less than 100 words explain why you want to be a Student Rep *

In the event of an election for the position you have nominated for this will be displayed on www.brunelstudents.com/reps

Attach a Photo

This must be a picture that clearly shows your face. You should be the only person in the picture. This photo will be used on the www.brunelstudents.com/reps pages and in various Student Reps promotional material. Should you not want your photo to be displayed then please leave this section blank

Date *

DD / MM / YYYY