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

The nomination form needs to be submitted by January 29, 2010.

University of Wisconsin-Fox Valley Foundation

Outstanding Alumni Award Nominations Form

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:

Describe the activities, achievements and/or contributions made by the
Nominee which qualifies him/her for the award

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: