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GSLAAB 2014 Leader Nomination Form

1. Default Section

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1. Award Being Nominated For:

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2. Name & Organization of Leader:

Name:

Organization:

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3. Breadth of Organization:

Discipline/Department Level

Schoolwide

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4. Listserv/Roster Size:

<25

25-100

100+

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5. Active membership (Average attendence for most events):

<10

10 to 25

25+

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6. Year in Graduate School:

1

2

3

4 or more

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7. Years of leadership in this organization / related organizations:

1

2

3

4 or more

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8. Previous positions in this organization/related organizations (reply none if none):

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9. Contact Info:

Your E-mail address:

E-mail to contact the individual (can be same):

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10. How does this leader meet the criteria for this award? Please see award descriptions. (500 words or less, less than 250 preferred. Feel free to use the words "I" and "my")