Alumni Recognition Awards Nomination Form

Select which award applies to your candidate*
- Distinguished Alumni Award
- Distinguished Educator Award
- GOLD Award
Nominee Information
Please ensure all names and titles are accurate. Information submitted may be used to prepare news releases and other promotional materials.
Nominee*
Year Graduated (if known)
Other College(s) attended and degrees attained (if known)
Home Address
Home Phone
Cell Phone
Business Phone
Email
Occupation
Title
Current Employer
Accomplishment and Impact*
In the area below, please list and describe the nominee’s professional accomplishments, including any leadership roles or elected positions. In your description, be sure to include the duties and impact the nominee may have had in those roles. Please include any special honors, awards, or other recognition this nominee has received.
Service*
Please list and describe the nominee’s service activities deserving special recognition, including voluntary service to UMPI and other volunteerism. For all voluntary service please list the number of years the nominee has been serving in each organization (if known).
Additional Comments
Nominator Information
Nominator*
Relationship to nominee
Address*
Email*
Phone*

Nominee Information