President's Diversity Fund - Committee Nomination

Nomination Form

To nominate yourself or another Evergreen community member or alumnus, please complete the nomination form.

Office for Diversity Affairs and Equal Opportunity
Paul Gallegos
Special Assistant to the President for Diversity Affairs

Sem I Annex B-102B
Phone: (360) 867-6368
Fax: (360) 867-6577
TTY: (360) 867-6995

Date:
Contact Telephone:
Your Name:
Your Email Address:
Nominee's Name (if other than yourself):
Nominee's Status (check one):	Student Staff Faculty Alumnus
Nominee's Email Address:
Telephone:
Mailing Address:
Supporting Statement: One page or less, indicating why you or your nominee would be a good addition to the committee. (See Committee Membership, Qualifications for criteria)