Semiannual Nomination Form

Make a Difference Awards

�� Michigan University Make A Difference awards are for staff compensation system, AFSCME, MESA and POA employees. If you know of a coworker or staff member who deserves recognition for outstanding service to ��, use this form to nominate him or her. Multiple nominations per employee are welcome, however individual nominations should be submitted by one person, not by a group or organization.

Please give specific examples of why your nominee deserves to receive the �� Make a Difference award. Selection is based on the information you, the nominator, provide for the committee. To assure your nominee will remain anonymous, please do not use your nominee's name or department within the text of your nomination.

*Required information

Nominee's full name (required)

Nominee's department (required)

Nominee's position

Nominee's supervisor

Your full name (required)

Your department

Your email (required)

Your affiliation

My nominee deserves a Make a Difference award because: (required)

To ensure unbiased selection, your nominee will remain anonymous. To ensure your nominee will remain anonymous to the committee throughout the selection process, please do not use your nominee's name or department within the text of your nomination.

Make a Difference
�� Michigan University
1903 W Michigan Ave
Kalamazoo MI 49008-5217 USA
Phone (269) 387-3620
Fax (269) 387-3441

��������

Make a Difference Awards

Semiannual Nomination Form

��