Company name:

Contact Person:

Address:

City:

Phone:

E-mail:

Reason for nomination: (Describe significant contributions that have benefited the University of Illinois at Chicago. In nominator's opinion, why does the nominee deserve this honor?):

Information About The Nominator

Nominated by:

Your address:

Phone number:

FAX number:

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

The information in this form is requested to nominate a corporation for an award and to update Alumni Association records. It will not be disclosed to anyone outside the University of Illinois without the nominee's permission.

Additional supporting material may be mailed to:

Chair, UIC CAAB Awards Committee
c/o University of Illinois Alumni Association
UIC Student Center East, 750 S. Halsted St., Suite 520
Chicago, IL 60607