Award Category

Project/Partnership Title

Type of community-engaged scholarship exemplified by this project

Scholar Information

In the case of a team of faculty/staff members, please repeat the above identifying Information for each individual (the first individual listed will be considered the primary contact).

Name of CSU Faculty/Staff Member

As it should appear on the award certificate

Academic Rank/Position

Department(s)

College(s) or Unit(s)

please list joint appointments, listing primary appointment first

Email Address

Office Postal Address

Office Telephone Number

Community Partner Information

In the case of multiple community partner organizations, please repeat the above

identifying Information for each.

Organization Name

As it should appear on the award certificate

Name of Representative

Add the name of the person who will represent the community partner(s) at the CSU Awards ceremony:

Email Address

Office Postal Address

An electronic copy (pdf) of the complete nomination packet must be received no later than 4 p.m. on January 24, 2024. No hard copies or late submissions will be accepted.

Attach your nomination packet here