Distinguished Service Award

Nomination Form

Calendar: Deadline for nominations is August 31.

One award per campus will be selected by the Campus Alumni Advisory Board and will be presented by the University of Illinois Alumni Association at Commencement or an Alumni Association event.

Should the Advisory Board determine the nominee would be more appropriately honored by means of a different award, it reserves the right to consider each nominee for other, more suitable recognition.

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 download the MS Word version:

INFORMATION ABOUT THE NOMINEE:

Nominee is a graduate of the following campus:

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

Home street address:

City:

State:

Zip code:

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.):

State why the nominee deserves this award and outline nominee's extraordinary commitment, dedication and service to the advancement of the University of Illinois:

Career since leaving the University:

Special recognitions, honors, awards or accomplishments that demonstrate the importance of an education at the University of Illinois:

Publications or patents:

Civic activities, philanthropic endeavors:

Other information of interest:

Nominee's family - name of spouse and children - indicate if any attended/are attending the University of Illinois and degrees (This information is optional.):

INFORMATION ABOUT THE NOMINATOR

Nominated by:

Your address:

Phone number:

FAX number:

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