YU Rock Nomination Form

Please be sure to complete all the fields below. Thank you for taking the time to recognize someone's contribution.

Information About You

Please provide us with your basic contact information in case we need to follow up with you about your nomination.
Your Name Your Name * First Last
Provide your first and last name
Your Email *

Provide your email address
Your Phone Your Phone * - ### - ### ####

Provide your phone number
Extension (if applicable)

Provide your York University phone extension if you are an employee of the University
Your Department (if applicable)

Provide your department's name if you are an employee of York University.
Today's Date Today's Date * / DD / MM YYYY

Add today's date as the submission date.
Information About Nominee(s)

Tell us about your nominee(s). If you are nominating a group, please add the entire list of names in the Additional Nominees field.
Name of Nominee(s) Name of Nominee(s) * First Last
Provide the name of the one employee you are nominating. If there is more than one employee you are nominating add additional names in the field below.
Name of Additional Nominees (for group nominations only)

If you are nominating a group add the additional names in this section.
Department of Nominee *

Select the department of the employee you are nominating.
Reason for Nomination

Tell us why your nominee(s) should be recognized with the YU Rock certificate. Remember to submit a brief description of the specific event/situation as the monthly committee uses this to determine if the nominee(s) meet the program criteria.
Date of Occurrence Date of Occurrence * / DD / MM YYYY

The date that the nominee displayed one of the below criteria.
Reason for Nomination (select only ONE) *

Reason for Nomination (select only ONE) Service Excellence (e.g. going above and beyond) Volunteerism (e.g. helps out colleagues) Positive Attitude (e.g. excellent customer service) Innovation (e.g. offers constructive solutions or new methods) Initiative (e.g. proactive actions and leading with positive actions) Team Work (e.g. working collaboratively) Health & Safety (e.g. working to mitigate risks) Leadership (e.g. to lead a group or provide guidance) Other (e.g. commitment) Other (e.g. commitment)

Select one criteria to describe the reason for your nomination.
Description: Tell us about the specific event/situation and the reason why your nominee(s) should be recognized. *

Tell us what the nominee did that made you want to recognize them.

YU Rock Nomination Form

YU Rock Nomination Form

Information About You

Information About Nominee(s)

Reason for Nomination