*1.Name & Department of Nominee(Required.)

*2.Email Address & Phone Number of Nominee(Required.)

*3.Value Represented by Nominee(Required.)

Innovation

Success

Partnerships

Integrity

Respect

Excellence

Diversity

4.How does the Nominee represent this value? Give detailed accomplishments, achievements, or examples of how the Nominee exemplifies this value.

5.Describe how the Nominee's accomplishments have had a positive impact on the division, department, or College by exemplifying this value.

6.Please provide any additional comments the committee should consider about the Nominee.