Ida J. Stockman Award - Nomination Form - Michigan Speech-Language-Hearing Association

Michigan Speech Language Hearing Association

Ida J. Stockman Award - Nomination Form

The Ida J. Stockman Award for Diversity and Infusion shall be awarded to members of the Michigan Speech-Language-Hearing Association in recognition of their contributions 1) to promote the fair treatment and full participation of all individuals with communication and swallowing disorders across service delivery settings, and/or 2) to increase the presence of populations who have historically been under-represented or subjected to discrimination because of their background, identity, or disability.

Please begin by entering your information, as nominator, below.

First Name *

Last Name *

Email *

Name of nominee: *

Email address for nominee: *

Work address for nominee: *

Work phone for nominee:

Nominee's present position or employer: *

Nominee's highest degree (please included year and institution): *

Nominee's current MSHA Membership status: *
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Please upload your written rationale for nomination for Ida J. Stockman Award for Diversity and Influsion (not to exceed four typed, double-spaced pages) *

Please upload a current vita of the nominee. *

Four letters of recommendation must accompany your nomination. At least two of the four letters must be written by current MSHA members in good standing.

Upload letter of recommendation #1 here. *

Upload letter of recommendation #2 here. *

Upload letter of recommendation #3 here. *

Upload letter of recommendation #4 here. *

Nominator's current MSHA Membership status: *
Choose 1