Attachment II

 

 

Nomination Form for Excellence in Diversity Award

 

NAME OF NOMINEE:

 

RANK/POSITION:

 

DEPARTMENT/OFFICE:

 

COLLEGE/DIVISION:

 

LIST AND GIVE A BRIEF DESCRIPTION OF DIVERSITY-RELATED ACTIVITIES ON CAMPUS (in chronological order):

 

 

 

 

 

 

 

 

 

 

 

 

 

OTHER ASSIGNMENTS RELATED TO DIVERSITY (e.g., committee memberships, involvement in campus organizations, professional advisory roles, etc.):

 

 

 

 

 

Nomination by/Contact Person:

 

Name:                                                Phone Number                    Email: ________________

 

Signature(s):                                                             Date: