woman of the year awards program

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:                                                                  

 

 

woman of the year awards program

Nomination Form

 

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 University of Michigan.

 

 

 

 

 

4.                  Describe how the nominee has demonstrated continued growth and progress in her career

development.

 

 

 

 

 

Nominator                                                                                            Date                            

 

Department                                                                                          Phone                          

 

Address                                                                                               Campus Zip                 

 

Nomination must be received by September 12, 2003.

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 University of Michigan

330 East Liberty Street  *  Ann Arbor, MI 48104-2289.