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The Faculty Senate
The Faculty Senate
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Distinguished Service Award
Nomination Form

From: ________________________________________________________________________
Your printed full name and signature

__________________ ____________________ ________________
Campus box number Campus phone number Date

I wish to nominate the following individual for a Distinguished Service Award:

______________________________________________________________________________

Summarize this person's service to the University, the region, or the State.

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

______________________________________________________________________________

In support of this nomination, attach as much of the following information as possible:

Date of birth
Degrees received and granting institutions
Appointments with educational institutions
Relevant career or experience history
Significant honors, achievements, and contributions
Societies, associations, or other memberships
Major publications
History of service given
Press releases, news stories, or other pertinent comments

Please send one nomination per form. Return to Craig Steiner, Chair, Honorary Degrees and Distinguished Service Awards Committee, Box 1608.