Awards Nomination

Alumni Awards Nomination Form

NOMINEE INFORMATION

Please complete the following form about the individual you seek to nominate. Nominations for these honors are due annually on March 31.

Fields marked with a red asterisk are required.

Last Name:

First Name:

Middle Initial:

Maiden Name (if applicable):

Address

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Phone Number

###

####

Email Address

Graduation Year:

NOMINATOR INFORMATION

Please provide your contact information so we may contact you with additional questions about your nominee.

Last Name:

First Name:

Middle Initial:

Address

Street Address

Street Address Line 2

City

State / Province / Region

Postal / Zip Code

Country

Phone Number

###

####

Email Address

Graduation Year:

AWARD YOU ARE NOMINATING THE ALUM

Please select one.

Old Gold Goblet*

Young Alumni Award*

Alumni Citation*

BUSINESS/PROFESSIONAL INFORMATION

Please provide a brief explanation of the qualifications of this nominee for a distinguished alumni achievement award. Please use your own words to list relevant accomplishments or other recognition. Additionally, please share how you believe the nominee has succeeded in their profession.

CONTRIBUTIONS TO DEPAUW UNIVERSITY

Please provide a brief explanation of the contributions this individual has made to DePauw University -- as a student and as an alumnus/alumna -- in the space provided below.

Academics

Admission & Aid