Faculty, Staff, and/or Student OUTstanding Service Award
We seek nominations of individuals within the Dickinson College community who identify as queer (LGBTQQIA) and have been actively involved in social justice work to create a more inclusive Dickinson community.

These individuals may have shown:

-Proven and documented leadership and service on campus to the LGBTQQIA community at Dickinson
-Dedication to working towards improving campus or community policies affecting LGBTIQQIA-identified persons;
-Solidarity and coalition building within the LGBTQQIA community

Please complete the nomination form below. Self-nominations are accepted.

There will be one (1) student and one (1) faculty, staff, or administrator selected for this award.

I wish to nominate:

Name of Nominee: *
Your answer
Nominee Status *
Nominee Address:
Your answer
Nominee Phone: (Including Area Code)
Your answer
Nominee E-Mail Address: *
Your answer
Brief Summary of Nominee's Contributions: *
Your answer
Nominated By: *
Your answer
Nominator Address:
Your answer
Nominator Phone Number: *
(Including Area Code)
Your answer
Nominator E-mail Address: *
Your answer
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms