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 CAMPUS-RELATED ACTIVITIES ON AND OFF CAMPUS THAT HAVE AN IMPACT ON CAMPUS FOR THE CAMPUS COMMUNITY, PLEASE DO NOT SUBMIT A VITA (in chronological order):

 

 

LIST THE IMPACT AND/OR PUBLIC GOOD FOR THE CAMPUS COMMUNITY: 

 

 

 

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: _____                                                     Date: