Fillable 2018-msa-application- University of Wyoming Alumni Association Medallion Service Award

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2018-msa-application- University of Wyoming Alumni Association Medallion Service Award

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UNIVERSITY OF WYOMING
MEDALLION SERVICE AWARD
NOMINATION FORM
UNIVE R SITY OF WY O M IN G MEDAL L I O N SERVICE AWARD NOMIN A TION
University of Wyoming Alumni Association
Medallion Service Award Nomination Letter
The University of Wyoming Alumni Association Medallion Service Award is given to
individuals who must meet the following qualifications:
1. The individual must have given unselfishly of his or her time, talent or support to
the University of Wyoming.
2. The individual must be a person of such integrity and stature that UW faculty,
staff, students, and alumni will take pride in his or her recognition.
People in the following categories are not eligible to receive the award:
1. Anyone who is a candidate for public office at the time of selection.
2. Any current member of the selection committee, UW Alumni Association Board
of Directors or UW Board of Trustees.
3. Any person who cannot be present to accept the award.
If you know of anyone you think should be considered for this honor, please complete
the attached form by February of each year and return it to the UW Alumni
Association, Marian H. Rochelle Gateway Center, 222 S. 22
nd
St., Laramie, WY 82070
Attn. Marisa Reilly. This form is also available as a PDF document on our website:
http://www.uwyo.edu/alumni/about-the-uwaa/da-msa/. Scroll to the bottom of the
page for the Medallion Service Award form.
In addition to completing the information required in the nomination form, nominators
should also submit letters of support for the nominee. No more than ten letters of
support are recommended.
2
Date_________________
UNIVE R SITY OF WY O M IN G MEDAL L I O N SERVICE AWARD NOMIN A TION
Date: ________________________
Name of person nominated _________________________________________________
Address _________________________________________________________________
City, State, Zip ___________________________________________________________
Office phone ( ) ___________________ Home Phone ( ) _____________________
Type of business __________________________________________________________
Present position and title ___________________________________________________
Is he/she a former UW student? _____________ (not required)
What significant contributions of time, talent or support of the University of Wyoming
has he/she made?
3
UNIVE R SITY OF WY O M IN G MEDAL L I O N SE RVI C E AWARD NOMIN A TION
What civic or philanthropic activities has he/she been involved? What honors has
he/she received?
If possible, please provide information about nominee concerning: family data, articles
or books authored, hobbies, etc. (If more space is needed, please use the back of this
sheet).
Name of person submitting nomination _______________________________________
Address _________________________________________________________________
City, State, Zip ___________________________________________________________
Office phone ( ) ___________________ Home Phone ( ) _____________________
4
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2018-msa-application- University of Wyoming Alumni Association Medallion Service Award

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Completed 13 February 2020

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