Loyalty Award for Exceptional Alumni Service Nomination Form

Thank you for submitting a nomination for the University of Illinois Loyalty Award for Exceptional Alumni Service. We look forward to learning more about your nominee. If you have any questions, feel free to contact us at advancement@uis.edu or 217-206-6058.

1. Your name and contact information

2. Nominee's full name (include name at graduation if different.)

3. University of Illinois degree(s) (Include dates conferred and college/school/department/major)

4. Nominee's degree(s) from other colleges/universities

5. Nominee's home address, and email address if known

6. Nominee's present occupation (Include title and company, profession, business address, phone and email if known; if retired, year of retirement.)

7. Statement of why the nominee deserves this award; outline nominee’s significant, notable and meritorious contributions of leadership or service, which demonstrate exceptional loyalty, commitment, dedication and service to the University of Illinois.

8. List nominee’s special recognitions, honors or awards from other organizations.

9. Statement of how the nominee’s actions could inspire alumni and students, and how his/her actions reflect the importance of a University of Illinois education.

10. Other information of interest

11. If you would like to upload any additional information, supporting documents, or letters of support, you can do so here. If files exceed the limit on this form, you can email them directly to advancement@uis.edu. (maximum file size: 15MB)

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Loyalty Award for Exceptional Alumni Service Nomination Form

Loyalty Award for Exceptional Alumni Service Nomination Form

1. Your name and contact information

2. Nominee's full name (include name at graduation if different.)

3. University of Illinois degree(s) (Include dates conferred and college/school/department/major)

4. Nominee's degree(s) from other colleges/universities

5. Nominee's home address, and email address if known

6. Nominee's present occupation (Include title and company, profession, business address, phone and email if known; if retired, year of retirement.)

7. Statement of why the nominee deserves this award; outline nominee’s significant, notable and meritorious contributions of leadership or service, which demonstrate exceptional loyalty, commitment, dedication and service to the University of Illinois.

8. List nominee’s special recognitions, honors or awards from other organizations.

9. Statement of how the nominee’s actions could inspire alumni and students, and how his/her actions reflect the importance of a University of Illinois education.

10. Other information of interest

11. If you would like to upload any additional information, supporting documents, or letters of support, you can do so here. If files exceed the limit on this form, you can email them directly to advancement@uis.edu. (maximum file size: 15MB)

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