Alumni Nomination Form - Alumni - Western Illinois University

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Alumni Award Nomination Forms

Select a form to fill out by choosing the award type below in the drop down list box.

WESTERN ILLINOIS UNIVERSITY
TOWN & GOWN AWARD
Nomination Form
To nominate an individual for the Town & Gown Award, please provide the following
information concerning the nominee (see criteria below):

Nominee Information: Name:

Address:

City: State: Zip:

Home Phone: Cell Phone: Email:

Business Title:

Company Name:

Address:

City: State: Zip:

Business Phone: Business Email:

Nominator Information: Nominator(s):

Address:

City: State: Zip:

Daytime Phone Number: Cell Phone: Email:

Award Information:

The Town & Gown Award is presented to an individual who has provided exceptional service to WIU and the community. Please list the nominee's contributions in the categories below. Additional supporting material (press release, awards, honors, etc.) may be included as well.

Nominations are kept on file and considered for the Town & Gown Award for three years. It is the responsibility of the nominator to update supporting information as needed.

Final selection will be made by the Town & Gown committee appointed by the Western Illinois University Director of Alumni Relations and the President of the University.

Applications must be received in the Alumni Office, Western Illinois University, 1 University Circle, Macomb, IL 61455-01390, no later than July 31.

Nominee Contributions: List and describe the contributions the nominee has made to Western Illinois University.

List and describe the contributions the nominee has made to Macomb community.

Upload a Resume or Biography:

Additional supporting materal (press releases, awards, honors, etc.) may be emailed to A-Association@wiu.edu after the submission of this form.

WESTERN ILLINOIS UNIVERSITY
HONORARY ALUMNI AWARD
Nomination Form
To nominate an individual for the Honorary Alumni Award, please provide the following
information concerning the nominee (see criteria below):

Nominee Information: Name:

Address:

City: State: Zip:

Home Phone: Cell Phone: Email:

Business Title:

Company Name:

Address:

City: State: Zip:

Business Phone: Business Email:

Nominator Information: Nominator(s):

Address:

City: State: Zip:

Daytime Phone Number: Cell Phone: Email:

Award Information:

The Honorary Alumni Award is presented to an individual who is not a WIU graduate but who has provded exceptional service to the WIU community. Please list the nominee's contributions in the category listed below. Additional supporting material (press releases, awards, honors, etc.) may be included as well.

Nominations are kept on file and considered for the Honorary Alumni Award for three years. It is the responsibility of the nominator to update supporting information as needed.

Final selection will be made by the Town & Gown committee appointed by the Western Illinois University Director of Alumni Relations and the President of the University.

Applications must be received in the Alumni Office, Western Illinois University, 1 University Circle, Macomb, IL 61455-01390, no later than July 31.

Nominee Contributions: List and describe the contributions the nominee has made to Western Illinois University.

Upload a Resume or Biography:

Additional supporting materal (press releases, awards, honors, etc.) may be emailed to A-Association@wiu.edu after the submission of this form.

WESTERN ILLINOIS UNIVERSITY INTERNATIONAL ALUMNI
ACHIEVEMENT AWARD
Nomination Form
To nominate an individual for the International Alumni Achievement Award, please provide the following
information concerning the nominee:

Nominee Information: Name: Class Year: Major:

Address:

City: State/Country: Zip:

Home Phone: Cell Phone: Email:

Business Title:

Company Name:

Address:

City: State/Country: Zip:

Business Phone:

Country of Birth:

Additional Graduate Study Year and Degree College or University

Year and Degree College or University

Nominator Information: Nominator(s):

Address:

City: State: Zip:

Daytime Phone Number: Cell Phone: Email:

Award Information:

Please list the nominee's accomplishments for each category on this form. Please include a resume or bio with the nomination form. Additional supporting material (press releases, awards, honors, etc.) may be include as well.

Nominations are kept on file and considered for the International Alumni Achievement Award for three years. It is the responsibility of the nominator to update supporting information as needed.

Final selection will be made by the Awards and Recognition Committee appointed by the Western Illinois University Alumni Council, the Director of Alumni Relations, and the President of the University.

Applications must be received in the Alumni Office, Western Illinois University, 1 University Circle, Macomb, IL 61455-01390, no later than August 1.

Nominee Contributions: List exceptional accomplishments in business or professional life.

List exceptional service in community affairs at local, state, or national levels.

List exceptional service to or for the continued excellence of Western Illinois University.

Upload a Resume or Biography: REQUIRED

Additional supporting materal (press releases, awards, honors, etc.) may be emailed to A-Association@wiu.edu after the submission of this form.

WESTERN ILLINOIS UNIVERSITY
DISTINGUISHED ALUMNI AWARD
Nomination Form
To nominate an individual for the Distinguished Alumni Award, please provide the following
information concerning the nominee (see criteria below):

Nominee Information: Name: Class Year: Major:

Address:

City: State: Zip:

Home Phone: Cell Phone: Email:

Business Title:

Company Name:

Address:

City: State: Zip:

Business Phone: Business Email:

Additional Graduate Study Year and Degree College or University

Year and Degree College or University

Nominator Information: Nominator(s):

Address:

City: State/Country: Zip:

Daytime Phone Number: Cell Phone: Email:

Award Information:

The Distinguished Alumni Award is the highest honor bestowed on an alumnus/alumna by the WIU Alumni Assocation. This award is given to alumni who have reached the pinnacle of their career and have brought credit to themselves and Western Illinois University through distinguished accomplishment in ALL of the following areas:

Business or professional life.
Community affairs at local, state or national affairs levels.
Support of the advancement and continued excellence of WIU.

Please list the nominee's accomplishments for each category on this form. Please include a resume or bio with the nomination form. Additional supporting materal (press releases, awards, honors, etc.) may be included as well.

Nominations are kept on file and considered for the Distinguished Alumni Award for three years. It is the responsibility of the nominator to update supporting information as needed.

Applications must be received in the Alumni Office, Western Illinois University, 1 University Circle, Macomb, IL 61455-01390, no later than December 1.

Upload a Resume or Biography: REQUIRED

Additional supporting materal (press releases, awards, honors, etc.) may be emailed to A-Association@wiu.edu after the submission of this form.

WESTERN ILLINOIS UNIVERSITY
YOUNG ALUMNI EXCELLENCE AWARD
Nomination Form
To nominate an individual for the Young Alumni Excellence Award, please provide the following
information concerning the nominee (see criteria below):

Additional Graduate Study Year and Degree College or University

Year and Degree College or University

Nominator Information: Nominator(s):

Address:

City: State/Country: Zip:

Daytime Phone Number: Cell Phone: Email:

Award Information:

The Young Alumni Excellence Award is presented to an alumnus who has made outstanding contributions in one or more of the following ways and has not yet acheived the age of 35:

Exceptional accomplishment in chosen field.
Exceptional service in local, state or national affairs.
Exceptional service in support of the advancement and continued excellence of WIU.

Nominations are kept on file and considered for the Young Alumni Excellence Award for three years or until they reach 35 years of age, whichever comes first. It is the responsibility of the nominator to update supporting information as needed.

Applications must be received in the Alumni Office, Western Illinois University, 1 University Circle, Macomb, IL 61455-01390, no later than December 1.

Upload a Resume or Biography: REQUIRED

Additional supporting materal (press releases, awards, honors, etc.) may be emailed to A-Association@wiu.edu after the submission of this form.

WESTERN ILLINOIS UNIVERSITY
ALUMNI ACHIEVEMENT AWARD
Nomination Form
To nominate an individual for the Alumni Achievement Award, please provide the following
information concerning the nominee (see criteria below):

Additional Graduate Study Year and Degree College or University

Year and Degree College or University

Nominator Information: Nominator(s):

Address:

City: State/Country: Zip:

Daytime Phone Number: Cell Phone: Email:

Award Information:

The Alumni Achievement Award is presented to an alumnus who has made outstanding contributions in one or more of the following ways:

Exceptional accomplishment in chosen field.

Exceptional service in local, state or national affairs.

Exceptional service in support of the advancement and continued excellence of WIU.

Nominations are kept on file and considered for the Alumni Achievement Award for three years. It is the responsibility of the nominator to update supporting information as needed.

Applications must be received in the Alumni Office, Western Illinois University, 1 University Circle, Macomb, IL 61455-01390, no later than August 1.

Upload a Resume or Biography: REQUIRED

Additional supporting materal (press releases, awards, honors, etc.) may be emailed to A-Association@wiu.edu after the submission of this form.

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