2016-17 Distinguished Teaching Awards Nomination Form
This form asks for information about the nominee, nominator(s), chair (if different), and dean. Dossiers must be submitted separately via email, per the nomination instructions.

PLEASE NOTE: Before completing this form, be sure you have the go-ahead to do so from your assigned "College Contact." This person is responsible for ensuring that your unit does not submit too many nominations. A link to the list of College Contacts is included in the nomination materials.

For which award is this person being nominated? *
Name of nominee *
Enter name as preferred in publicity and on certificate, e.g. Jane G. Jones.
Your answer
Nominee's email *
Your answer
Nominee's department
Your answer
Nominee's collegiate unit *
Your answer
Nominee's office phone *
Your answer
Nominee's cell phone
Your answer
Nominee's home phone
Your answer
Campus *
Job title *
Your answer
Job category *
Highest degree *
Your answer
Year conferred *
Your answer
Initial position at the University of Minnesota (rank and year) *
e.g. Assistant Professor, 2005
Your answer
Subsequent position (rank and year) if applicable
Your answer
Subsequent position (rank and year) if applicable
Your answer
Is this a re-nomination *
Name of nominator *
Your answer
Email address *
Your answer
Name of co-nominator, if applicable
Your answer
Email address
Your answer
Name of Department Head/Director *
Your answer
Email address *
Your answer
Name of Dean *
Your answer
Email address *
Your answer
Name of person completing this form *
Your answer
Email address *
Office phone number
Your answer
Additional information or comments
Thank you for completing this form.
Your answer
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