Ohio Wesleyan University | Alumni & Friends | Distinguished Achievement Nomination Form

Distinguished Achievement Nomination Form

The Alumni Association's highest honor recognizing alumni for professional accomplishment and/or outstanding service to humankind.

Note: Fields marked with an asterisk (*) must be filled in prior to submitting this form.

Nominee's Information

*Full Name:

*Home Address:
(line 1)

Home Address:
(line 2)

*Home Telephone Number:
(+ area/country code)

Work Telephone Number:
(+ area/country code)

*Home e-mail Address:

Work e-mail Address:

*Occupation:

*OWU Class Year:

*Educational Background:

*Occupational History:

*Publications:

*Check as appropriate:

	This person has achieved and sustained significant national recognition among his/her colleagues for professional accomplishments.
	This person's services over a significant period of time directly and profoundly improved the quality of life for humankind.

*Please describe this nominee's achievement:

*Previous (non-OWU) awards and recognitions:

*Other facts and comments about the nominee:

*How long have you known this person?

*In what capacity have you known this person?