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OUTSTANDING SERVICE TO UNIVERSITY SENATE GOVERNANCE
2015 NOMINATION FORM
Please fill out this form by typing responses in the gray boxes.
NAME OF NOMINEE:
NOMINEE’S CONTACT INFORMATION:
Email:
Phone:
Department:
SERVICE
Nominee must have served at least 8 years (does not have to be consecutive years served) as one or more
of the following:
 Member - Senate Committee or Subcommittee
 Chair - Senate Committee or Subcommittee
 Senator – University, Faculty, P&A, or Civil Service Senate
 Alternate – P&A Senate
 Parliamentarian or Clerk – University Senate
Note: Outstanding service will be counted for P&A employees who served on the Council of Academic
Professionals and Administrators (CAPA) and/or the Academic Staff Advisory Council (ASAC) and civil
service employees who served on the Civil Service Committee (CSC).
The University Senate Office will confirm nominee’s eligibility and provide their record of service.
Contact the University Senate Office at [email protected] or 612-625-9369.
QUESTION 1 – CONTRIBUTIONS AND IMPACT
Based on your personal knowledge, describe briefly in the space below nominee’s contributions and
impact to University Senate Governance:
QUESTION 2 – INSPIRATION TO OTHERS
Based on your personal knowledge, describe briefly in the space below how nominee has inspired
others to serve in University Senate Governance:
NOMINATION SUBMITTED BY:
Name:
Email:
Phone:
SUBMISSION DEADLINE: March 12, 2015
SUBMISSION OF NOMINATION FORM
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