Recipient Name:

Classification:

Department: (if not a student)

Recipients Email:

Select the Learning Environment principles demonstrated:

Briefly state what the recipient did:

Date of Action: (mm/dd/yy)

Name of Awarder:

Gift Awarded: $5 Wawa gift card

The next step is for you to print the LEAP certificate generated after you hit “submit” and hand-deliver to the award recipient. This will allow them to redeem their LEAP prize at the Business Office. This form is replacing the traditional LEAP cards.