Name of School

							                 SWE Certificate of Merit Nomination Form (FY11-12)
Please provide the following information:

Name of School: ___________________________________________________________

Address: _________________________________________________________________

         _________________________________________________________________

Phone number: (_____) _______________________________________

Email address: ______________________________________________________

Contact person: ____________________________________________________________

Date of Awards Assembly: ___________________________________________________
                        (Required field, as this date will appear on the certificate)

The certificates will be sent to the contact person at the school. Please submit this request form as
an email attachment, 4 weeks in advance of your presentation, or by April 1, 2012 (whichever is
earlier) to Mary Whalon at marywhalon@motorolasolutions.com. In return, all submitters will
receive an email acknowledgement as a confirmation.

Please indicate below the young women you have selected for Certificates of Merit. Certificates read
“SWE certificate of merit for (__Honor) in science and mathematics, presented to (name) in
recognition of three years’ excellence in these courses”.

1.      With Highest Honor

        Name: _____________________________________________________________

2.      With High Honor

        Name: _____________________________________________________________

3.      With Honor

        Name: _____________________________________________________________

If it can be arranged and your school is in Colorado, would you want a SWE representative to present
the certificate(s) at the awards assembly? If neither box is marked, it is assumed the response is
“No”.
                                   Yes                     No

If a SWE representative is available to present the certificate (s) at the awards assembly, the school
will be contacted at least one week in advance of the event for the assembly details.

Please submit this form as an email attachment to:                    For questions, please contact:
Mary Whalon at                                                        Mary Whalon at (303) 909-1886
marywhalon@motorolasolutons.com