2021 PCDI Awards Nomination Form

JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.

The President’s Commission on Disability Issues (PCDI) established the PCDI Achievement Awards to recognize faculty, staff, students and individual units that have made outstanding contributions to the University’s equity and accessibility efforts.

Please submit your nomination by March 22nd, 2021. Awards will be presented at the Disability Summit in April 2021.

Email *

Nominator Name *

Nominator email address *

Nominator's Role *

Faculty

Staff

Undergraduate Student

Graduate Student

Other:

Required

Type of Award Nomination *

John W. King Staff Award | Exempt Staff and Non-Exempt Staff (including Contingent Staff)

Faculty Award | Tenured, tenure-track, non-tenured, or professional faculty (part-time or full-time)

Undergraduate/Graduate Student Award

Outstanding Unit Service Award | Academic or Administrative Unit

PCDI Leadership Award

Required

Name of Nominee or Unit representative *

Email of Nominee or Unit representative *

Phone Number of Nominee or Unit representative *

Please provide detailed information about the nominee's contributions or accomplishments related to service to our community with disabilities, accessibility and equity. List specific examples of how the nominee met the criteria for the award. Limit response to 250-500 words.

What impact has the nominee contributed to the disabled community and how? Please provide specific examples. Limit response to 250-500 words.

What other individuals might comment on the contributions or accomplishments of the nominee? Please provide their name, email address, and phone number.

Is there anything else you think the selection committee should know about the nominee? Limit response to 250-500 words.

Submit

Clear form

Never submit passwords through Google Forms.

This form was created inside of University of Maryland, College Park. Report Abuse

Forms