AWARD CATEGORY: FACULTY/STAFF

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1 Call for Nominations The were established by Palm Beach State College to honor individuals and organizations that have made major innovative contributions toward improving the lives of others, particularly the underserved, through leadership, service and/or programs. These contributions can include the areas of education, diversity, race relations, social justice and economic empowerment. AWARD CATEGORY: FACULTY/STAFF General Instructions & Requirements New! ELIGIBILITY CRITERIA: The nominee must be a current Palm Beach State College faculty or staff (full time or regular part time employee) and must have completed at least six months of employment and in good standing. The nominee must have performed exemplary service to improve the quality of life for an underserved group, whether in the classroom, student life, faculty or staff relations, or through community outreach linked to the College. The packet must include ALL of the following: SUBMISSION OF NOMINATION PACKET 1. Completed Nomination Form: All pages and questions must be completed. Incomplete forms will result in nomination being ineligible for consideration. New! Please note, in additional to your signature, your application must have two additional signatures attesting to the information provided in support of the nomination and endorsing the candidate. 2. Letter of Nomination: Provide a signed letter of your nomination, summarizing why you believe the nominee should be recognized (one page only). 3. Documentation demonstrating contribution made: Example - news articles, sample of work, event flyers. (This is optional, but strongly encouraged to support your nomination) Nomination packets must be hand delivered, postmarked, or submitted electronically by 5pm on Friday, November 17, 2017 in order to be considered. Hand deliver to: Mail to: Fax to: Duncan Theatre Box Office, 4200 Congress Ave., Lake Worth Hours of operation: Monday Friday, 10am 5pm Dr. David Pena Director, Library Learning Resource Center Palm Beach State College 3160 PGA Boulevard, MS#45 Palm Beach Gardens, FL (561) MLKCelebration@palmbeachstate.edu Please note: If the nominee is selected for the award, you will be required to submit a high resolution photograph and a biography of words of the candidate by November 30, For information about the Dr. Martin Luther King Jr. Celebration, us at: MLKCelebration@palmbeachstate.edu, or call

2 NOMINATION FORM Nominee Information: Award Category: FACULTY/STAFF Name of Nominee: Business Business Business Address: City: State: Zip: Description of 2

3 Nomination Information: (Provide a detailed and compelling description of related activities and/or community service, creation of initiative relevant to the eligibility criteria that the nominee has contributed to. Include nominee s personal commitment to local community and civic service.) 3

4 Description of Volunteerism: (Describe efforts and/or time and resources nomination has dedicated to service activities) 4

5 Description of Population Impact: (Describe population and reach. Include community or profile of individuals impacted by nominees work. Please quantify where applicable.) 5

6 List awards received by nominee for contributions to community life related to the eligibility criteria: (If applicable) List Articles or Acknowledgements: (If applicable) 6

7 Nominator Information: Nominated by: Mail Address: City: State: Zip: 1. Endorsed by: Name: 2. Endorsed by: Name: 3. Endorsed by: Name: 7

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