School of Science

Infinite Mile Award

Nomination Form  

NOMINEE INFORMATION

Name:

______________________________________________________

Department/Laboratory:

______________________________________________________

Title:

______________________________________________________

Address:

______________________________________________________

Telephone:

_____________________Email:____________________________

NOMINATOR INFORMATION

Name:

______________________________________________________

Department/Laboratory:

______________________________________________________

Title:

______________________________________________________

Address:

______________________________________________________

Telephone:

_____________________Email:____________________________

 

PLEASE ATTACH LETTER OF SUPPORT FOR YOUR NOMINEE

Please mail nomination form and support letter to the administrative officer / personnel administrator in your respective department / laboratory / center for review.

(This section to be filled out at the departmental level.)

Comments: (Optional)

 

 

 

 

  

Reviewed by_________________________________________________________________________