* 1. Name of Manager/Supervisor you are nominating:

* 2. Your name:

* 3. Your email:

* 4. Name of your unit/department (no acronyms please):

* 5. Primary Work Location

* 6. My manager/supervisor promotes work-life integration through the following actions:

* 7. My manager/supervisor provides me with opportunities to learn, grow and succeed in my work and career through the following:

* 8. My manager/supervisor really cares about my well-being demonstrated through the following actions:

* 9. My manager/supervisor has made my unit/department aware of the following UC Davis resources:

* 10. Feel free to share below any stories or examples of how your manager/supervisor is a WorkLife Champion:

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