UC Health Nomination

What is the name of the Candidate?*

What is the Title/Role of the Candidate?*

What is the Race/Ethnicity of the Candidate?*

Native American
Asian/East Indian
Black/African American
Hispanic/Latino
Multi-Racial
Native Hawaiian/Pacific Islander
White

What is the Gender of the Candidate?*

Male
Female
Other

What is the email address of the Candidate?*

What is the best phone number to reach the Candidate?*

What are the years of service of the Candidate?*

Less than 6 Months
6-12 Months
1-3 Years
3-6 Years
6-10 Years
10-15 Years
15-20 Years
20-30 Years
30 Years or More

What is the Council Location of the Candidate?*

UC Medical Center (UCMC)
West Chester Hospital
Daniel Drake Center for Post-Acute Care
UC Health Business Center
UC Health Ambulatory - North
UC Health Ambulatory - South

How would you rate the Candidate's job performance overall?*

How would you rate the candidate's overall knowledge of the organization?*

How would you rate the candidate's communication skills overall (listening and ability to articulate their feelings and ideas)?*

How would you rate the candidate's sensitivity, empathy and compassion for others (an awareness and respect for the feelings and experiences of others).*

How would you rate the candidate's genuineness (capacity to be trusted, respected by peers, honest with self and others)?*

How would you rate the candidate's willingness to learn (self-awareness and awareness of others who are different from them)?*

How would you rate the candidate's enthusiasm for creating a positive and inclusive work environment for everyone?*

How would you rate the candidate's willingness to invest their time and energy to create a positive and inclusive work environment for everyone?*

Provide additional comments:

What is your name?*

Please enter today's date:*

Nomination Criteria for UC Health’s Diversity, Culture & Inclusion Council

Pope Consulting

Is your organization struggling to create an inclusive, high-performing culture?