Schol Uw Alanshepard

Questions? Call Elsie Nisonen in the Convocation and Awards Office at 416-979-5000 ext. 3145 Name of Nominee: Program: Telephone: Email: Indicate Award category (check all applicable criteria): ❏ Regularly demonstrates behaviours reflecting equity, diversity and inclusion, and champions the ideals of equity, diversity and inclusion ❏ Takes action to identify and address systemic barriers to full participation in university life and supports the university community to be an inclusive and welcoming learning, working and living environment. ❏ Develops unique/innovative programs that significantly enhance Ryerson's ability to facilitate full participation, and provide opportunities for the entire Ryerson community to reap the benefits of studying and working in an equitable, diverse and inclusive environment. ❏ Committed to and takes action to serve underrepresented populations (among students/faculty/sta ff) to provide access and opportunities to those who might not otherwise be part of our community, and once here may not be fully welcomed and included. Signature of Nominee: Date: Name of Nominator: Department/Fa culty: Email: Telephone: Signature of Nominator: Date: Please check off the inclusion of the required documents (ensure all are included): ❏ Completed Nomination Cover Page signed by both the nominator and nominee (electronic signatures are accepted). ❏ Nomination Brief (1 to 2 pages) prepared and signed by the nominator. ❏ Citation (no more than 150 words) suitable for public release, to be prepared by the nominator. ❏ Minimum of 3 Letters of Support (not exceeding 1 page in length each) that provide specific examples of why the nominee should be considered for the award from a broad spectrum of the Ryerson community, including students, facult y and staff. ❏ Photo consent form. NOTE: The nomination package must not exceed a total of 10 pages, all pages should be numbered consecutively. The completed package should be submitted electronically to Elsie Nisonen, Convocation and Awards office at enisonen@ryerson. ca by the deadline or paper versions can be submitted to KHS-47. Deadline for nomination package submission: September 19, 2014 (Noon) Recipients announced October 15, 2014 and Awards presentation: Fall 2014 at the recipient’s program department’s award presentation PRIVACY PROTECTION FOR AWARD APPLICANTS: In accordance with Section 39(2) of t he Freedom of Information and Protection of Privacy Act (FIPPA), the information on this form is collected under the authority of the Ryerson University Act, 1977 and is needed to adjudicate the nomination or application for the above-mentioned award. All personal information that is collected will be used, disclosed, stored, and destroyed in accordance with Ryerson University's Procedure for Protecting Restricted Information and Providing Access to Information which is part of the Information Protection and Access Policy (see http://www.ryerson.ca/about/vpadministration/asseets/pdf/InformationProtectionandAccessPolicy.pdf). If you have questions about the collection, use and disclosure of this information by the university, please contact the Convocation and Awards office at [email protected].

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Schol Uw Alanshepard