Aztlan Chicano Awards 2012
Exit this survey

1. Aztlan Chicano Awards 2012

Nomination Form

The award was created to honor Chicanos/Latinos who have made significant contributions to the university and/or the local community as well as Chicanos/Latinos whose work has forwarded Chicano/Latino issues. In many cases the honorees have done both.

Deadline: Friday, March 2, 2012
For questions or more information contact Professor Marisela Ramos at mramos@pacific.edu

1. I would like to nominate the following Chicano/Latino Leader:

I would like to nominate the following Chicano/Latino Leader: Nominee Name:
E-mail:
Phone:

2. Nominator Information (You)

Nominator Information (You) Your Name:
Your Relationship to Nominee:
Phone:
E-mail:

3. Nominee Status

Nominee Status ____ Current Pacific Student

____ Pacific Faculty Member/Administrator

____ Pacific Staff Member

____ Community Leader

4. How is this nominee a Chicano/Latino leader?

How is this nominee a Chicano/Latino leader?

5. Please provide an illustrative example of the nominee's leadership.

Please provide an illustrative example of the nominee's leadership.

6. Please describe the significance or impact of the nominee's contributions and achievements.

Please describe the significance or impact of the nominee's contributions and achievements.

Aztlan Chicano Awards 2012Exit this survey

1. Aztlan Chicano Awards 2012

Aztlan Chicano Awards 2012
Exit this survey