PRESIDENT’S DISTINGUISHED SERVICE AWARD FOR STAFF

University of Pittsburgh at Greensburg

NOMINATION FORM - FY 2010

NAME:
CAMPUS ADDRESS:	CAMPUS PHONE:
DATE OF HIRE AT PITT-GREENSBURG (FOR 3-YEAR ELIGIBILITY REQUIREMENT):
CURRENT POSITION:
DEPARTMENT:
IMMEDIATE SUPERVISOR:
DUTIES PERFORMED: Attach a detailed summary of the nominee's current job duties and responsibilities or a copy of the Job Description.
NOMINEE'S SIGNATURE	DATE:
NOMINATOR'S SIGNATURE	DATE:

Please return this form with other nomination materials no later than:

4:00 p.m.

Thursday, December 3, 2009

to:

President’s Distinguished Service Award for Staff

Dr. Sharon P. Smith, President

Lynch Hall 101

Revised November 10, 2009