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The Ruth Roemer Social Justice Leadership Award
2015 Nomination FormDeadline: February 27, 2015
The Ruth Roemer Social Justice Leadership Award is named in honor of Dr. Ruth Roemer for her 70 years of extraordinary service and contributions to social justice with lasting national and international impact. The award is presented to an individual who has shown commitment to social justice issues through outstanding service and support of vulnerable populations. The award consists of a plaque inscribed with the recipient’s name and will be presented at “The Annual Ruth Roemer Social Justice Symposium.”
CRITERIAFor the purpose of this award, commitment to social justice is exemplified in the work of Ruth Roemer and the services provided were intended to protect, advance, or recover the health and welfare of special populations. Priority shall be given to an individual whose work is replicable, sustainable, and scalable.
NOMINATION PROCESSThe nominator is responsible for submission of completed form and related material listed below:
Completed nomination form. Letter from the nominator describing achievements of the nominee. CV or resume of the nominee Letters of support from community leaders and professionals in the related field (limit of 10 letters).
Nomination packets can be sent electronically or via U.S. mail. Electronic material should be received prior to the deadline and sent to:
Manasa [email protected]
Nomination packets sent via the U.S. Postal Service or other carrier by first class mail should be postmarked by the deadline date and sent to the address below:
Manasa Prabhakar-DiLapoUCLA Fielding School of Public HealthOffice of External AffairsBox 951772, 16-080 CHSLos Angeles, CA 90095-1772
(310) 825-5119
Selection Process The Ruth Roemer award Committee will review all nominations and select the award winner. Announcement of the award winner will be published in the UCLA Public Health Magazine.
The Ruth Roemer Social Justice Leadership Award
2015 Nomination FormDeadline: February 27, 2015
NOMINEE INFORMATION
Full Name
Degree(s)
Title
Organization
Mailing Address
City State Zip Code
Telephone Number Fax Number
NOMINATOR INFORMATION
Full Name
Title
Organization
Mailing Address
City State Zip Code
Telephone Number Fax Number
Signature Date
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The Ruth Roemer Social Justice Leadership Award
2015 Nomination FormDeadline: February 27, 2015
Describe in detail the current work, distinguished achievements, or distinguished service which make this nominee worthy of the award.
List positions (titles and dates) held during performance of work for which nomination is suggested:
List publications relevant to achievements on which nomination is based:
The Ruth Roemer Social Justice Leadership Award
2015 Nomination FormDeadline: February 27, 2015
List awards and other recognition received by the nominee:
Other relevant information:
You may attach a letter to address the above requested information.