Diversity Award Nomination Form

Who is being nominated? *

Clear Selection
If an individual, is the nominee a current member of ACCCA? *

Clear Selection
Full name(s) of nominee(s) *
Title(s) of nominee (if individual)
Focus of nominee - if group or organization (in 900 characters or less.)

Contact information for nominee:

Address: *
City: *
State: *
Zip: *
Phone: *
Nominee Email: *

Your contact information (if different from nominee):

Address:
City:
State:
Zip:
Your Phone: *
Your Email: *

AWARD CRITERIA VERIFICATION
This section must be completed in order to have the nomination considered by the selection committee.

Please describe (in 900 characters or less) how the nominee or nominated organization has demonstrated leadership in promoting diversity in a higher education setting. *
Please list (in 900 characters or less)any existing documentation (research, reports, program or grant outlines, etc.) that would support this nomination. (Any documentation in support of this nomination may be uploaded using the fields below or mailed to the ACCCA office.) *
Upload supporting document
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Please list (in 900 characters or less) any presentations (at the state or national level) made by the nominee or on behalf of the nominated organization that impacts, enhances or represents the contribution of the nominee toward the goal of diversity in higher education. *
In the case of a nominated ORGANIZATION OR GROUP, please describe (in 900 characters or less) the development of inclusion via established policy (i.e., activities on campus or within the organization) or any organizational documentation which represents effective actions taken by the nominee toward progressing diversity.





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