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Nomination Form

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Phenomenal Women of USI and the Community
Nomination Form
Deadline: February 7, 2013
Nominee Information:
Full Name:

First Name
M.I.
Last Name
Address:
City:
State:
Zip Code:
Daytime Phone: Ex. 812-465-1080
Email Address:
Employer, community affiliation, or relevant position:
 
Award Information:
Please Choose:
 
Activities Undertaken:
In the space below, please describe the nominee's outstanding service. Please limit your response to 500 words, or less. As a guide, you may wish to consider some of the following questions:
  1. In what role(s) or area (s) has the nominee excelled?
  2. How has the nominee demonstrated service worthy of recognition?
  3. How has the nominee's contribution to diversity impacted a particular field, group, community, or humanity at large?
  4. Over what period of time has the nominee made a major commitment?
  5. Has the nominee's contribution been recognized elsewhere (i.e.: the media, by other awards, interest groups, churches, professional organizations, etc.)?
Nominator Information:
Nominated By:

First Name
M.I.
Last Name
Address:
City:
State:
Zip Code:
Daytime Phone: Ex. 812-465-1080
Email Address:
 

Complete this form online; send nominations to University of Southern Indiana, Multicultural Center, 8600 University Blvd. Evansville, IN  47712; send to Loriena Maldonado at the USI Multicultural Center via email or fax to 812/461-5287. 


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Copyright © 2013 University of Southern Indiana. All rights reserved.

NOMINATIONS ARE DUE BY
FEBRUARY 7, 2013
2012 Recipients

back l to r: Kaitlyn M. Webster, Molly Hahn, Mary Alice Weigand, Cynthia Brinker, Kendra Vanzo, Erika Taylor
 front r to l: Grisel Barajas, Amie R. McKibban, Genevieve B. Bootz, Sheila Huff
Diversity is the differences and similarities among groups of people and individuals based on race, ethnicity, socioeconomic status, gender, language, abilities, religion, sexual orientation, and geographic region in which they live.