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Copyright © Emory University
Atlanta, GA 30322

 


 

Membership Nomination Form

 

Nominee Information
Fields in red are required
 
Name
Department
Title
Years at Emory
Campus Address
Please Select One Faculty: Staff: Student:
Campus Phone
Home Phone  
Email
How did you hear about Nominations?
For Student Nominees Only
Undergraduate: Graduate: Professional School:
School/Department
Class Standing
Supervisor/Dean/Academic Advisor
Campus Address
Previous Involvement with Race and Ethnic Issues at Emory
please complete in detail
Other Emory Committee/Involvement
Has the Nominee been contacted and expressed an interest?
If not, please contact the nominee before you submit this form.
  Yes: No:
Nomination submitted by
Contact phone
RETURN ALL NOMINATIONS BY MARCH 6, 2009 TO:

PCORE Nominating Committee
c/o Provost's Office of Community and Diversity
305 Administration Building