Dan and Carole Burack President's Distinguished Lecture Series
Nomination Form for Fall 2016 and Spring 2017 Lectures
Nominee:
Position:
Place of Employment:
Describe how the nominee has cultivated national and/or international recognition in their field:
Describe how the speaker will have a positive impact across disciplinary boundaries on campus and where
appropriate please note the relevance to current activities at UVM or in Vermont:
Describe the potential lecture topic in one to two sentences:
Additional Documentation
1. Please attach a Letter of Support from a campus community member outside of your home department or
program. Supporting statements may come from faculty, students or groups on campus.
2. Please attach the nominee’s Curriculum Vitae (limited to 5 pages) or a brief Biography (1 – 2 pages).
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Name(s) of Nominator(s) and Department(s)
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Signature of Dept. Chair who will provide administrative support to primary host
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Print Name of Primary Host
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Signature of Primary Host
Please forward completed, signed forms to 347 Waterman, Attn: Gary Derr or
Gary.Derr@uvm.edu by Monday, March 21, 2016.