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UC Health Nomination
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UC Health Nomination
Nomination Criteria for UC Health’s Diversity, Culture & Inclusion Council
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?
*
Select Answer Below
Very Strong
Strong
Somewhat Good
Acceptable
Somewhat Weak
Weak
Very Weak
How would you rate the candidate's overall knowledge of the organization?
*
Select Answer Below
Very Strong
Strong
Somewhat Good
Acceptable
Somewhat Weak
Weak
Very Weak
How would you rate the candidate's communication skills overall (listening and ability to articulate their feelings and ideas)?
*
Select Answer Below
Very Strong
Strong
Somewhat Good
Acceptable
Somewhat Weak
Weak
Very Weak
How would you rate the candidate's sensitivity, empathy and compassion for others (an awareness and respect for the feelings and experiences of others).
*
Select Answer Below
Very Strong
Strong
Somewhat Good
Acceptable
Somewhat Weak
Weak
Very Weak
How would you rate the candidate's genuineness (capacity to be trusted, respected by peers, honest with self and others)?
*
Select Answer Below
Very Strong
Strong
Somewhat Good
Acceptable
Somewhat Weak
Weak
Very Weak
How would you rate the candidate's willingness to learn (self-awareness and awareness of others who are different from them)?
*
Select Answer Below
Very Strong
Strong
Somewhat Good
Acceptable
Somewhat Weak
Weak
Very Weak
How would you rate the candidate's enthusiasm for creating a positive and inclusive work environment for everyone?
*
Select Answer Below
Very Strong
Strong
Somewhat Good
Acceptable
Somewhat Weak
Weak
Very Weak
How would you rate the candidate's willingness to invest their time and energy to create a positive and inclusive work environment for everyone?
*
Select Answer Below
Very Strong
Strong
Somewhat Good
Acceptable
Somewhat Weak
Weak
Very Weak
Provide additional comments:
What is your name?
*
Please enter today's date:
*
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