Have you witnessed an SIU School of Medicine Employee who has gone above and beyond their job duties?

Use this form to acknowledge an exemplary act performed by an SIU School of Medicine employee who you believe promotes, displays, and truly lives the SIU School of Medicine Behavior Standards.

Instructions: Complete the form providing as must information as you can.
If you have questions regarding the completion of this form, contact Human Resources at 545-2076.

Name   Enter the name of the nominee.
Department (Organization)

From the drop down list, select the name of the department where the appointee is/will be employed.
The employee consistently meets the following behavior standards. (Please check those that apply)

• Collaboration and Partnership
• Compassion and Respect
• Integrity and Accountability
• Diversity and Inclusion
• Continuous Improvement

Event Description Provide a description of thesituation involving the employee yu are recognizing that clearly demonstrates he/she meets the criteria of the Harbinger of Goodwill award.

Name of Nominator The nominator should sign the form before submitting if sending hard copy. If submitting via e-mail, the name of the nominator should be entered.
Nominator’s Department (Organization)
From the drop down list, select the name of the department where the nominator is employed.
Phone Enter the Nominator Phone Number
Date Nominated The date the nominator signed the form.

Download your nomination form here.