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Run: DE&I Champion Recognition Nomination Form

Use this DE&I Champion Recognition Nomination Form to document inclusive behaviors, the people affected, and the impact in a consistent way. It helps HR and ...

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Nominee Information

Nominee full name (required)

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? (required)

Briefly describe the inclusive behaviors that make this person a strong DE&I champion.

Which inclusive behaviors did they demonstrate? (required)

Describe the specific actions you observed (required)

Include concrete, observable examples rather than general praise.

Impact and Outcomes

What impact did their actions have? (required)

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 (required)

Your work email (required)

Used only for nomination follow-up and review communication.

Consent to share nomination details with the review committee (required)

By submitting, you consent to the collection and internal sharing of the information provided for recognition review purposes.

Yes No N/A

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Email (required)

Your name (optional)

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