NOMINATION FORM
Please circle only one category:
Human Relations (improved group dynamics within the University community, at the unit level or beyond)
Leadership (outstanding
service as a project leader, administrator or peer leader)
PLEASE PRINT OR TYPE:
Full Name of Nominee:
Title(s):
Department:
Campus Address:
Campus Address: Campus Zip:
Telephone:
Email Address:
Number of years in University employment:
Describe in detail below the service of this nominee for each criteria. A current resume should accompany this completed nomination form. Feel free to attach additional pages if necessary but please limit your response for the questions below to two (2) pages. Please note that the selection committee will not consider any additional pages over the two-page limit.
1. Describe the contribution(s) that the nominee has made within the past twelve (12) months.
2. Describe how the nominee’s contribution(s) listed above has(have) made a significant impact on improving conditions for women of color in her department or academic unit.
3. Describe how the nominee has made
significant impact on improving the quality of life for all women of color at
the
4. Describe how the nominee has demonstrated continued growth and progress in her career
development.
Nominator Date
Department Phone
Address Campus
Zip
Please email the form to WCTF Awards Selection Team at Wctf-awards@umich.edu
or, mail a copy to:
Janice Reuben, WCTF Program Coordinator
Center for the Education of Women
The