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Outstanding Alumni Award Nominations Form

This award recognizes outstanding alumni who reflect the ideals of the University of Wisconsin – Fox Valley and whose achievements and contributions within their field of work or in their community have made a significant difference.

The recipient must:

  • Be an alumnus/alumna of the University of Wisconsin-Fox Valley and must have completed at least 2 semesters of work at the university.
  • Have completed work at the University of Wisconsin-Fox Valley at least 10 years ago.
  • Demonstrate outstanding achievement and/or leadership in his/her chosen profession
  • Contribute to improving the quality of life in their community
  • Provide inspiration to others
  • Cannot be serving on the UW-Fox Valley Foundation Board of Directors at the time of his/her nomination

All nominations must be submitted by January 31, 2013

Nominee's Info

Outstanding Alumni Nominee:

Address:

City: State: Zip:

Home Phone: Business Phone: (xxx) xxx-xxxx

Business/Organization Affiliation:

Title:

Dates attended UWFox, if known:

Academic Achievements-Please list names(s) of institution(s) and year of completion

  1. Bachelor's Degree:

  2. Master's Degree:

  3. Doctoral Degree:

Career Achievements-Please list all leadership positions held with companies (use as much space as necessary)

Describe involvement and positions held with local, national and international career associations (use as much space as necessary)

List and describe other distinguished achievements/service awards/recognitions received (use as much space as necessary)

List and describe all associations/affiliations and leadership positions in non profit/service groups (use as much space as necessary)

Nominator's Info

Nominated by:

Email Address: *required

Relationship, if any, to nominee:

Is nominee aware of this nomination? Yes No

Address:

City: State: Zip:

Home Phone: Business Phone: (xxx) xxx-xxxx

Business/Organization Affiliation:

Title: