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: