Each month, SOURCE highlights an individual “Champion of the Month” from one of our 3 participating JHU health professional schools (JHSPH, SOM, SON). This is a great way to acknowledge a student, faculty, or staff person from our schools for their outstanding contribution to community engagement activities here in Baltimore.

* 1. Nominator's name:

* 2. Nominator's email:

* 3. Nominator's school affiliation:

* 4. Nominator's phone:

* 5. Nominee's name:

* 6. Nominee's email:

* 7. Nominee's school affiliation:

* 8. Nominee's phone:

* 9. Is the nominee a student, faculty of staff member?

Answer the following questions for your nominee. Provide as much thoughtful information as possible about the individual to help inform the selection committee’s decisions.

* 10. Describe the community engagement experience the nominee has participated in/led this academic year (include the name of the community organization(s) that the nominee worked with during their service experience).

* 11. Why do you feel the nominee deserves this recognition?