Edith R. Bullock Prize for Excellence
Nomination Form
(The First Page of this Form Is Required for All Nominations)
1. Name of Nominee: _____________________________________________
2. Address of Nominee: _____________________________________________
_____________________________________________
3. University Affiliation of Nominee (faculty, staff, student, alum, supporter, etc.):
_____________________________________________
4. University Department, Institute, College, Campus, or Organization most closely identified with the
Nominee:
_____________________________________________
5. Why is this person being nominated for the Edith R. Bullock Prize for Excellence? This portion of the
nomination is the primary determinant of the quality of the nomination. It should outline in detail
what accomplishment, characteristic or activity of the nominee demonstrates the nominee's excellence
in support of the University.
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
________________________________________________________________________
(Use additional sheets as necessary)
6. A recent, within 2 or 3 years résumé or curriculum vitae for the nominee must be attached. Do not
include voluminous lists of publications. If nominee does not have such a résumé, the attached form
may be used as a guide for its creation.
7. No more than 3 supporting letters from other members of the university community or from the public
should be included. The references should relate to the requirements of the award.
8. Name of person submitting nomination: _____________________________________
Relationship (if any) to the University: ______________________________________
Signature (required): ____________________________________________________
Address: ______________________________________________________________
______________________________________________________________
Telephone Number: _______________________
click to sign
signature
click to edit
Edith R. Bullock Prize for Excellence
Information to be submitted in lieu of resume
Name of Nominee: _______________________________________________________
Employment History
Dates Employer Position Held
______ - ________ _____________________________ ____________________
______ - ________ _____________________________ ____________________
______ - ________ _____________________________ ____________________
______ - ________ _____________________________ ____________________
______ - ________ _____________________________ ____________________
Higher Education
Dates Institution Degree Granted
______ - ________ _____________________________ ____________________
______ - ________ _____________________________ ____________________
______ - ________ _____________________________ ____________________
Professional and Community Memberships and Affiliations:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
Significant Publications, Projects, or Professional Accomplishments:
_______________________________________________________________________
_______________________________________________________________________
_______________________________________________________________________
__________________________________________________________________
Chrome Web Store
It looks like you haven't installed the Fill Chrome Extension Add to Chrome