University Libraries Diversity Award Nomination Form
Please fill out the following form completely. All fields are required. In addition to this form, please attach up to two pages describing why the nominee is qualified for the award. Additional materials (program brochures, flyers, press clippings, etc.) are encouraged and do not count in the two page limit.
Is the nominee aware of your nomination? (circle one) yes / no
Briefly summarize why you think your nominee deserves this award (250 words)
Nominee’s Information
Full Name (or name of committee, department or unit):
Title (if applicable):
University Affiliation (student, faculty, etc.):
Local or Campus Mailing Address:
Email Address:
Telephone Number:
Nominator Information (person completing this form)
Full Name:
Title:
University Affiliation:
Local or Campus Mailing Address:
Email Address:
Telephone Number:
Mail to:
John Meier
201 Davey Lab
University Park, PA 16802
All nominations MUST be received by 5:00 pm, March 30th, 2012.
