Diversity Leadership Award
NOMINATION FORM
Name of Nominee
First
MI
Last
Banner ID
University Address
Phone
Nominee Email Address ________________________________
(Circle One)
Student
Staff
Faculty
Admin.
Title
Parent’s/Significant Other Name(s) and Address(es)
Phone(s)
Nominator(s) Name
Phone
Nominator(s) Email:
Please specifically address each of the following questions:
1. How has the nominee contributed to the success of programs and activities that seek to advance
equity and justice?
2. What has the nominee done to foster awareness of and shared commitments to equity and justice in
others?
3. Describe how the nominee has fostered leadership development among his/her constituents.
4. How has the nominee demonstrated an understanding of the interconnectedness of multiple
social justice issues?
Deadline: Wednesday, Jan. 12, 2011 by 12:00 noon to
the Office of Vice Provost for Diversity
134 Alumni Center – ML 4512 or nunezc@xavier.edu