Devi Bhargava Faculty/Staff Nomination Form

This form is for students to nominate faculty and staff for the Devi Bhargava Faculty Award. Please nominate any faculty or staff member who advocates especially well for students with disabilities. Nominations are due by 4:00pm on May 8, 2015. Thank you.

Faculty/Staff Information
Provide the first and last name of the faculty or staff member you are nominating.
Where in the college does the faculty or staff member work? Be specific such as Arts & Sciences Spanish teacher or Applied Arts office.
Please describe how the faculty member or staff person has helped students (yourself or others) who have a disability. Please include specific examples. You may type directly on the form or copy and paste from a Word document.
Is there any other information you would like to share with the committee?
Nominator's Information
Please include your first and last name.
Please include your phone number so we may contact you if we have questions.
Upload a file that you would like to include with your nomination. The maximum file size is 2GB. The file must be named using only letters and numbers, no special characters. Allowed file types include: gif, jpg, png, pdf, doc, docx, txt, ppt, pptx, xls, xlsx.