Distinguished Alumni Achievement Award Nomination Form

If you have any questions or need additional information, please contact the Office of Development and Alumni Relations in the College of Arts and Sciences at 205.996.2534 or thecollege@uab.edu.

Nominator Information

Name:(*)
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Major/Department:(*)
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Phone Number (ex. 205-555-5555):(*)
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Nominee Information

Name:(*)
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Degree(s):(*)
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Class Year(s):(*)
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Employer:(*)
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Occupation:(*)
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Address:(*)
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City:(*)
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State:(*)
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Zip Code:(*)
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Email:(*)
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Phone Number (ex. 205-555-5555):(*)
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Type:(*)
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List professional accomplishments, including any leadership roles, elected positions, or other activities deserving special recognition. Please include a brief description of duties and the impact the nominee may have had in those roles. A copy of the nominee’s CV or resume may also be attached to the nomination form.

Professional Accomplishments:(*)
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Upload CV or Resume:
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List examples of nominee's voluntary service on a local, state, national or international level including clubs, service organizations and community involvement.

List of Nominee's Service:(*)
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Contributions to the UAB College of Arts and Sciences: (*)
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Additional Comments:
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