Distinguished Alumni Nomination Form

Please fill out the form as completely as possible. The process of selection for the Distinguished Alumni Award is highly confidential. Please avoid notifying the individual concerning your nomination.

I. Nominee Information

Nominee's name:
Maiden name:
Address:
City:
State:
Zip:
Phone:
E-mail:
Year of graduation:
Employer:
Position:

II. Nominee Supporting Information

Career achievements in his/her field:

Community service activities:

Involvement in UW-Green Bay (please include both past and present):

Additional reasons why you feel this nominee should receive the award:

III. Nominator Information

Your name:
Address:
City:
State:
Zip:
Daytime phone:
E-mail:

For additional information, please contact Alumni Relations at 920-465-2586 or via e-mail at alumni@uwgb.edu.

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