DE&I Champion Recognition Nomination Form

A nomination form for recognizing employees who actively build a more inclusive environment by amplifying quieter voices, advancing belonging, and modeling inclusive behaviors.

Nominee Information

• Nominee full name
• Nominee department
  Optional if the nominee is easily identifiable in your organization.
• Nominee role or job title

Recognition Summary

• Why are you nominating this person?
  Briefly describe the inclusive behaviors that make this person a strong DE&I champion.
• Which inclusive behaviors did they demonstrate?
• Describe the specific actions you observed
  Include concrete, observable examples rather than general praise.

Impact and Outcomes

• What impact did their actions have?
  Explain how their actions improved inclusion, participation, trust, or belonging.
• Approximate number of people positively affected
• Primary area of impact

Recognition Details

• When did this behavior occur?
  Use the most recent or most representative date if the behavior occurred over time.
• Additional context
  Optional details such as project context, team setting, or recurring behaviors.
• Supporting file
  Optional supporting documentation such as a meeting note, email excerpt, or recognition artifact.

Submitter Information

• Your name
• Your work email
  Used only for nomination follow-up and review communication.
• Consent to share nomination details with the review committee
  By submitting, you consent to the collection and internal sharing of the information provided for recognition review purposes.