Nominee:

Department:

Position:

Campus Address :

Campus Phone #:

Nominator:

Department:

Campus Address:

Campus Phone #:

1. CLAS students, staff, or faculty may nominate an eligible CLAS candidate. All full-time and part-time (at least 50% effort) budgeted CLAS staff are eligible to be nominated for volunteer acts of service that are taking place during the current fiscal year and/or took place last year. Prior to completing the nomination form, please obtain permission from the nominee.

2. Materials are to be assembled by the nominator and must include:

a. This nomination form.

b. Brief description of the candidate’s community service activity.

c. Supporting statement from someone in the organization with concrete knowledge and understanding of the nominee’s community service (include contact information). Please paste a copy of this statement into the following field.