Staff Awards Nomination Form

Medical School Administration Awards Program
2002 Nomination Form

Nominee:

Name:

Title: Office:

Campus Address:

Zip: Phone:

Please provide address information for each staff member nominated for the Outstanding Team Award.

Award Category:

Proficiency
Team
Leadership

Nominator:

Name:

Title: Office:

Campus Address :

Zip: Phone:

E-mail

Describe the nominee's contributions to the Medical School. Please be specific in your examples and refer to the criteria listed.

You may submit your nomination by clicking the submit button or print the form and mail it to:

Human Resources and Staff Development
6319 Medical Science Bldg. I, Box 0624

Nomination forms must be received by December 6, 2002