WLU Awards Nomination Form

Submit this form for each candidate nominated for the 2019 WLU awards by April 1, 2019.

Question Title

* 1. Nomination for the award of (check one):

Lifetime Membership Award

Service Award

Reclaiming the Joy of Teaching Award

Please provide the following information to ensure that all potential candidates are evaluated on the same criteria. Note: All nominations are treated as confidential.

Question Title

* 2. Nominee Information

First Name:

Last Name:

Address:

City / State / Zip:

Email:

Phone:

Institution:

Question Title

* 3. Please describe nominee's accomplishments relevant to the nominated award (1,000 word maximum):

Question Title

* 4. Nominator Information:

First Name:

Last Name:

Address:

City / State / Zip:

Email:

Phone:

Institution:

Relationship to Nominee:

Length of time you have known nominee: