Nomination Form

Shining Heels

Do you know someone that volunteers at the local shelter, gives up their Saturdays to be a big brother or big sister, visits the sick or elderly or performs any other service for the community? If so, we want to know about them. We are recognizing UNC staff employees who are outstanding contributors to their communities and would like to have your nominations. Individuals will be selected from your nominations and introduced in future University Gazette publications with an article and photograph. We want these individuals to know how much we appreciate them making our communities better places to live. Nominations should be submitted by Wednesday, March 31, to Dixie Bloom, 422 Rosenau Hall, CB# 7400, dixie_bloom@unc.edu or via fax at 966-0222.

You may print this form and mail it in or simply e-mail the details to Dixie Bloom at dixie_bloom@unc.edu

Nominator Information:

Date Submitted: ____________________________________

Name: _______________________________________________________________

Department: ___________________________________________________________

Campus Telephone Number: ______________________________________________

Nominee Information:

Name: ________________________________________________________________

Department: ___________________________________________________________

Campus Telephone Number: _____________________________

Brief summary as to why you are recommending this individual:

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

Names of additional individuals who would share comments regarding the nominee:

Name & Telephone Number: ____________________________________________

Name & Telephone Number: ____________________________________________