AZA 2010 Diversity Award Application

Angela Peterson Excellence in Diversity Award

2017 A p p l i c a t i o n

All applications are due by close of business on June 1, 2017, and must be compiled into one PDF file.

Please make sure the file name reflects both the award name and the institution. Abbreviations are fine.

AZA has contracted with WEBCARGO to provide a quick and easy way for you to submit your application. Please submit your application using this link:

WEBCARGO allows you to send large files via email, without the need to reduce their size. There is no need to sign up, nothing to install andnothingto download. All deliveries are encryptedso security is not an issue and WEBCARGO sends confirmation when your file is received.The upload speed varies depending on your Internet Service Provider and the size of your file so you may need to be patient. Please send a note to support.webcargo.netif you need assistance with the upload.

Questions? Please contact Barbara Pueschel (; 301-244-3326).

See 2017Angela Peterson Excellence in Diversity Award Guidelines for information about completing this application.

A. CANDIDATE

Program Title:

Has this program previously been submitted for an AZA award? Yes No

If yes, did it win an award? Yes (Top honor Significant achievement) No

B. APPLICANT

Institution Name:

Address:

Name of Director:

Signature of Director:

C. Program Summary— maximum of one single-spaced page in 12-point type.

D. GOALS and OBJECTIVES—maximum of one single-spaced page in 12-point type.

E. PROGRAM NARRATIVE—maximum of three (3) single-spaced pages in 12-point type.

F. EVALUATION—maximum of two (2) single-spaced pages in 12-point type.

G. SUPPLEMENTAL/NARRATIVE SUPPORT MATERIALS

H. PARTICIPATION/COLLABORATION/RECOGNITION

I. IMAGE—one digital image that illustrates the program to be used during the Awards Ceremony.

J. SUBMITTER

The SUBMITTER is that person responsible for the contents of the entry. Failure to provide an electronic signature on the designated line will constitute an incomplete application.

Name:

Title:

Signature:

Date:

E-mail address:

K. NEWS RELEASE FORM

Submit the News Release Form (available at with the application and also email the form as a WORD document to Barbara Pueschel:

L. WINNER’S RELEASE: HELP YOUR FELLOW MEMBERS!

If yours is the winning application, would you be willing to have it posted on the AZA website as an example for future applicants?

Yes No

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