Center for Diversity & Inclusion

LGBTQA Awards Nomination Form

Due by April 7th, 2013

Please fill in the below form to nominate someone for a LGBTQA Award. All descriptions can be found on our Awards Page. All nominations are due by Sunday April 7th, 2013.

Please contact the Center for Diversity & Inclusion with any questions.

Name of Candidate:

Phone:

Email:

The following is intended for student nominees

Dept/Major (if known):

Estimated GPA (for academic award only):

Intended Graduation Date (if known):

Answer each question as thoughtfully as possible.

For which award are you nominating this person?:

Academic Award

Alumni Award

Grad Student Award

Intersections Award

Leadership Award

Outstanding 1st/2nd Year Award

Mindy Michels Award (Outstanding Staff/Faculty Award)

Please submit a separate form for each award in which you would like to nominate someone.

How long have you know the candidate and to what level?:

Why do you think this person should be recognized?:

Please identify three characteristics or accomplishments that distinguish this person from others.:

Please list any extracurricular activities in which this person is involved - on or off campus.:

Additional Information or Comments:

Will you be able to attend this ceremony on Wednesday, April 24rd at 6pm in SIS Founder's Room?

Please Choose:

Yes

Nominator Information

Submitted By:

Date:

Department/Major:

Phone:

Email:

Degrees

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Center for Diversity & Inclusion

LGBTQA Awards Nomination Form

Due by April 7th, 2013

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