Distinguished Service Award Nomination Form

Bestowed upon alumni, faculty, staff and friends by the University of Illinois at Chicago Alumni Association. The award is presented to individuals or couples whose consistent, exceptional and meritorious service to the University has made a significant impact on the institution’s overall welfare and the advancement of its mission.

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Criteria

Nominees must:

Be an individual living at the time of nomination
Nominee must hold an earned degree from University of Illinois Chicago
Be of such stature, demonstrated ability, and renown that alumni, students, faculty, and staff of the University of Illinois Chicago will take pride in and be inspired by his/her recognition

Those not eligible:

Previous recipients
Current members of the UI Board of Trustees, the University of Illinois Urbana-Champaign Alumni Association, University of Illinois – Springfield Alumni Association or University of Illinois Chicago Alumni Board, the Awards and Nominations Committee members, relatives, employers, or employees thereof
Current faculty and staff of the University
Persons currently holding or running for elected state or federal public office in Illinois

Nominee Information
Name * Required
First Last
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone * Required
Email * Required
Nominator's University Affiliation * Required
- UIC Advancement Staff
- UIC Leadership, Faculty, or Staff
- UIC Alumni
- Other
TED ID

If the nominator is NOT a member of the UIC Advancement team, please type "N/A" in this box.
Was this person nominated for this award in the past? * Required
- Yes
- No
- I don't know
Please list degree(s) earned at UIC: * Required
UIC degree college(s): * Required
Year(s) of UIC graduation: * Required
Please list degrees earned from other colleges/universities:
Year(s) of graduation from other colleges/universities:
Present occupation * Required
Include company, title, profession, business address, etc. If retired, please include date of retirement.
Executive Summary * Required
In a paragraph or less, please provide a high-level summary of the nominee's qualifications for this award.
Please list any special recognitions, honors, and/or awards: * Required
Please list any publications and/or patents:
If the nominee's publications and/or patents are included as part of his or her resume/CV, please leave this field blank and upload the detailed resume/CV below.
Please describe the nominee's civic activities and/or philanthropic endeavors:
Please add any additional information about the nominee here:
Letter of Support 1 * Required
Max. file size: 2 MB.
At least one letter of support is required for this award. Nominators are strongly encouraged to submit multiple letters of support.
Maximum file size - 2 mega bytes.
Letter of Support 2
Max. file size: 2 MB.
At least one letter of support is required for this award. Nominators are strongly encouraged to submit multiple letters of support.
Maximum file size - 2 mega bytes.
Letter of Support 3
Max. file size: 2 MB.
At least one letter of support is required for this award. Nominators are strongly encouraged to submit multiple letters of support.
Maximum file size - 2 mega bytes.
Resume/CV
Nominators are strongly encouraged to provide additional supporting documentation about the nominee, including a detailed resume/CV and/or relevant recognitions, honors, awards, or accomplishments.
Accepted file types: pdf, jpeg, pngandword, Max. file size: 15 MB.
Document 2
Max. file size: 15 MB.
Nominators are strongly encouraged to provide additional supporting documentation about the nominee, including a detailed resume/CV and/or relevant recognitions, honors, awards, or accomplishments.
Document 3
Max. file size: 15 MB.
Nominators are strongly encouraged to provide additional supporting documentation about the nominee, including a detailed resume/CV and/or relevant recognitions, honors, awards, or accomplishments.
Nominator Information
Name * Required
First Last
Address * Required
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone * Required
Email * Required

Distinguished Service Award Nomination Form

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Nominee Information

Nominator Information

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