Levin Impact Award

Are you nominating yourself?

Nominee prefix (Dr., Rev., Hon., Mr., Ms., Mx., etc.)

Nominee's first name

Nominee’s middle name or initial

Nominee's last name

Nominee's suffix (Jr., Sr., II, III, etc.)

Nominee's current title or role (Enter the nominee’s current professional, civic, academic, or community role.)

Nominee’s employer or organization

The nominee is not currently affiliated with an employer or organization.

Confirm nominee’s email address

Confirm email

Nominee’s telephone number

Street address 1

Street address 2

City

State

Zipcode

Is the nominee an alumnus or alumna of Levin College or one of its predecessor units? Note: Alumni status is required for the Levin Impact Award.

Yes

Degree earned

Academic program or major

Graduation year

College, school, department, or predecessor unit

Brief professional biography. Provide a summary of the nominee’s current role, career path, professional or community leadership, and principal areas of work.

Describe the scope of the nominee’s impact. Describe the nominee’s impact at the regional, state, national, or international level. Include specific examples of meaningful and lasting change in place, policy, practice, institutions, communities, or society.

Nominator prefix (Dr., Rev., Hon., Mr., Ms., Mx., etc.)

Nominator's first name

Nominator's last name

Nominator's title

Nominator's employer or organization

Confirm nominator's email address

Confirm email

Nominator's telephone number

What is your relationship to the nominee? (For example: colleague, supervisor, former student, mentor, friend, family member, community partner, etc.)

What is your relationship to Levin College?

Describe your relationship to Levin College. Examples include alumnus/alumna, faculty or staff member, donor, community partner, employer, volunteer, advisory board member, or other.

Are you submitting this nomination on behalf of a Levin College academic unit?

Yes

Levin College academic unit

Please provide a nomination statement.

In no more than 1,000 words, explain why the nominee should receive the Levin Impact Award. Describe how the nominee meets the award criteria and provide specific examples of the nominee’s professional achievement, leadership, service, and impact.

Where relevant, address:

Distinguished achievement and leadership in the nominee’s profession, field, or community
Significant impact at the regional, state, national, or international level
Sustained service, innovation, collaboration, or community advancement
Meaningful and lasting change in place, policy, practice, institutions, communities, or society
How the nominee’s accomplishments reflect the mission and ideals of Levin College

Self-nominees may submit this statement on their own behalf.

Upload the nominee's résumé or curriculum vitae

One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

Upload one additional supporting document (optional) (Examples include a letter of recommendation, professional biography, award citation, or summary of accomplishments.)

One file only.
100 MB limit.
Allowed types: txt rtf pdf doc docx odt ppt pptx odp xls xlsx ods.

I confirm that the nominee has agreed to be nominated for the Levin Impact Award and has authorized the submission of the information and materials included with this nomination.

I agree to be considered for the Levin Impact Award and authorize Cleveland State University to review the information and materials included with this nomination.

I certify that the information provided in this nomination is accurate to the best of my knowledge.

I understand that Cleveland State University may contact the nominator or nominee if additional information or clarification is needed.

I understand that submission of a nomination does not guarantee selection for an award.

I understand that the nomination and supporting materials will be available only to authorized Cleveland State University personnel involved in administering and reviewing the awards.

Events

Contact Information

Selection and Notification

Questions

Submit a Nomination

Nomination Type

Nominee Information

Confirm nominee’s email address

Nominee’s Connection to Levin College

Nominator Information

Confirm nominator's email address

Nomination Statement

Supporting Materials

Contact Information

Events

Contact Information

Levin Impact Award

Selection and Notification

Questions

Submit a Nomination

Nomination Type

Nominee Information

Confirm nominee’s email address

Nominee’s Connection to Levin College

Nominator Information

Confirm nominator's email address

Nomination Statement

Supporting Materials

Consent and Certification

Contact Information