HLAA Inclusive Excellence Award Nomination Form

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Nominator Information

Name:(*)

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Program(s) from which you graduated:(*)

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Email:(*)

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Phone Number:(*)

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Nominee Information

Name:(*)

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Program(s) from which the nominee graduated:(*)

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Employer:(*)

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Title:(*)

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Email:(*)

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Phone Number:

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Describe the nominee's commitment to diversity, equity, inclusion, and cultural competence in the following areas.

A. Demonstration of leadership and results in diversity, equity, inclusion and cultural competency in their organizations, community and/or the field(*)

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B. Active engagement in supporting UAB students and alumni individually, through the program, HLAA and/or Department.(*)

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C. Demonstrates the Department’s values and a commitment to improving health and health care and creating organizations where all can thrive.(*)

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Additional information

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Supporting Materials - OPTIONAL

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reCAPTCHA(*)

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HLAA Inclusive Excellence Award Nomination Form

Nominator Information

Nominee Information