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					                                              Central Michigan University

                                          Distinguished Alumni Award
                                                Nomination Form

This award is presented to a graduate in recognition of his/her remarkable professional success and the positive
reflection made on the reputation of all graduates of Central Michigan University.
Criteria:
1. Achieved a high level position within his/her chosen field of endeavor by attaining increasingly responsible
   positions with companies/organizations. (Worth up to 40 points)
2. Received recognition from peers through honors and awards from professional organizations. (Worth up to
   25 points)
3. Recognized for significant contributions/discoveries/patents/creative work by national or international news
   media. (Worth up to 25 points)
4. Other evidence of remarkable professional success. (Worth up to 10 points)

The Nominee
Name:                                                             Maiden Name:

Home Address:                                                     City:                                    State:

Zip code:                           Country (if other than U.S.):                   Home Telephone:

Professional Title or Position:

Employer (Company Name):

Employer Address:

City:                                      State:          Zip code:                     Country (if other than U.S.):

Business Telephone:                                        E-mail address:

Educational Background
Institution:                                                              Degree:                           Year:

Institution:                                                              Degree:                           Year:

Institution:                                                              Degree:                           Year:

If possible, please attach the nominee’s résumé or curriculum vita.

Occupational History (list most current position first)
Employer:                                             Position:                                            Dates:

Employer:                                             Position:                                            Dates:

Employer:                                             Position:                                            Dates:

Employer:                                             Position:                                            Dates:
Current Professional Affiliations
Affiliation:                                      Position:                                     Dates:

Affiliation:                                      Position:                                     Dates:

Affiliation:                                      Position:                                     Dates:

Affiliation:                                      Position:                                     Dates:

Affiliation:                                      Position:                                     Dates:

Awards and Honors (Worth up to 25 points)




Outstanding Achievements in Field (Worth up to 40 points)




Involvement with Central Michigan University




Significant Contributions/Discoveries/Patents etc. (Worth up to 25 points)




Other Professional Success (Worth up to 10 points)


Nominees Class Year:


The Nominator
Name:                                                         Maiden Name:

Home Address:                                                 City:                             State:

Zip code:                       Country (if other than U.S.):                Home Telephone:

Daytime Telephone:                                    E-mail address:

Relationship with Nominee:_________________________________________

Deadline for Submission:      April 10, 2010.

Questions: Call the Office of Alumni Relations at (989) 774-3312 or e-mail us at alumni@cmich.edu.
Thank you very much for your nomination. The 2010 Alumni Awards Dinner will be held in the Fall of 2010.

				
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