Fillable Nomination for Honorary Diploma (The Michener Institute of Education at UHN)

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Nomination for Honorary Diploma (The Michener Institute of Education at UHN)

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Country of origin: CANADA
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educational programs.
____________________________________________________________________________________________________
Nomination for Honorary Diploma
PART I - NOMINEE
Criteria (Nominees must meet one or both of the following criteria. Please check appropriate boxes):
Accomplished in the field of health care (broad definition) and/or post-secondary education nationally or
internationally.
Accomplished in a professional discipline that aligns with The Michener Institute for Education
educational programs.
Accomplished in a community of professional practice that aligns with The Michener Institute for Education at
Prefix: _____________ Name: ____________________________________________________________________________
Address: _____________________________________________________________________________________________
Short Description of Nominee (physician, technologist, teacher, e tc.):
PART II -NOMINATOR
Prefix: _____________ Name: ____________________________________________________________________________
Address: _____________________________________________________________________________________________
Phone Number: __________________________ E-Mail Address: _______________________________________________
Relationship to Michener: _______________________________________________________________________________
The Honoree will be required to work in consultation with the nominator or the Honorary Diploma Committee to prepare
a brief profile to be read at Graduation, as well as provide a photo to be used in promotional materials and for a
permanent plaque that is displayed at Michener.
Please include:
☐ Letter of recommendation outlining the reasons for your nomination
☐
☐ Letters of Support (optional)
Nominator s Signature: ______________________________________ Date: _______________________________
I have read, and accept the nomination:
Nominee s Signature: ________________________________________ Date: _______________________________
Kindly forward nominations to Ray Nielsen at RNielsen@Michener.ca before October 15, 2020
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Nomination for Honorary Diploma (The Michener Institute of Education at UHN)

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Completed 10 February 2021

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