Your Name (required)

Your Email (required)

Your Phone Number

Your Status
 faculty student

Faculty Member’s Name or Student’s Name

Degree

School

Area of Specialization

Check One
 Faculty Nominee Graduate Nominee Undergraduate Nominee

Academic Activities

Awards

Other

PLEASE WRITE A SHORT PARAGRAPH ON WHY YOU THINK THIS FACULTY MEMBER OR STUDENT SHOULD BE A RECIPIENT OF THIS AWARD (e.g., dedication, ability, availability, involvement with students, community service, etc.).