Calendar: Deadline for nominations is Sept. 30. Up to two awards per year may be selected from each campus by the Constituent Management Committee. The award will be presented by the University of Illinois Alumni Association at an Alumni Association event or a constituent association event.

Send nominations to:

University of Illinois Alumni Association
Alice Campbell Alumni Center
601 S. Lincoln Ave., MC-077
Urbana, IL 61801
Fax: 217/333-7803
E-mail: alumni@uillinois.edu

PLEASE NOTE: This form contains several entry boxes for long blocks of text. The Alumni Association recommends that nominators first review the form, then compose the text in a word processing document and save it, and then copy and paste the contents into the form. This will help ensure that elements of the nomination are not irretrievably lost during the process, and it creates a copy of the nomination for the nominator.

If you experience any difficulties with this online form, please contact the Alumni Association at 217/333-1471, or fax the nomination to 217/333-7803, or send e-mail to alumni@uillinois.edu.
You also can use the MS Word version:

INFORMATION ABOUT THE NOMINEE:

Nominee is a graduate from or is affiliated with:

PLEASE SELECT ONE Urbana-Champaign Chicago Springfield

Full name (Include name at graduation in parentheses, if different.):

Home street address:

City:

University of Illinois degree(s) received:

Class year:

College/School/Department/Major:

Nominee's degrees from other colleges/universities:

Present occupation (Include title and company, profession, business address, etc.; if retired, date of retirement.):

Please state how the nominee exemplifies the criteria for this award:

Additional letters of support (no more than three) are encouraged.
Send letters to:
University of Illinois Alumni Association
MC-388
Alice Campbell Alumni Center
601 South Lincoln Avenue
Urbana, IL 61801
PH: 217/333-1471 or 800/355-2586
alumni@uillinois.edu

Nominated by:

Your address:

Phone number:

FAX number:

Your e-mail address (necessary in order to process this form):

Constituent Group sponsoring nomination (required information):

 
 
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