ILLINOIS STATE UNIVERSITY



ILLINOIS STATE UNIVERSITYDepartment of PsychologyDiversity Advocate AwardApplication Deadline: April 1Type in the required information in the boxes, which will expand as needed. Email electronic copies of the completed application electronically to the Awards Committee Chair at jeffreywagman@illinoisstate.edu.Name FORMTEXT ?????Date FORMTEXT ?????Local Street Address FORMTEXT ?????City, State, Zip Code FORMTEXT ?????University ID FORMTEXT ?????Phone FORMTEXT ?????? I am a psychology major. Classification (freshman, sophomore, junior, senior): FORMTEXT ?????? I am a graduate student in psychology. Program/sequence and year: FORMTEXT ?????? I certify that I am not on academic probation. Diversity-related ExperienceActivity DatesOrganization or activity (note any office held):From (MM/YY)Until (MM/YY) FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ????? FORMTEXT ?????Provide a statement about why you believe the Department of Psychology should award you the Diversity Advocate Award. Please include details about your campus and/or community activities that demonstrate your commitment to diversity, inclusion, and/or safe environments. Please do not exceed 300 words. FORMTEXT ?????? I certify that the information on this application is factual and true to the best of my knowledge.Your Name: FORMTEXT ?????Date: FORMTEXT ?????The following document should be submitted to the department’s Awards Committee Chair at jeffreywagman@illinoisstate.edu:A completed applicationRevised: November 2020 ................
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