Nomination Form
WIND Alum of the Year
Name of Nominee
Current Address
Phone # E-mail
UW Graduation Year Minor in Disability Studies: ___________
Yes/No
D
egree(s) Attained (List all, including graduate degrees):
____
___________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Nominee being in the following category/categories (check all that apply)
____
_ Professional Recognition _____ Leadership _____ Advocacy
____
_ Engagement and/or Support of WIND _____ Community Service
Nominated by
Address
Phone # E-mail
N
ominations need to include the following:
• This completed form
• Updated 1-2 page bio that includes descriptions of work nominee has been doing as well as 2-3 major
accomplishments since graduation
• Letter in support of your nomination OR letter in support of your self-nomination. Letters should include
enough information so the committee can make an informed decision. Letters should address at least one o
f
the criteria: Professional Recognition, Leadership, Engagement and Support of WIND, and/or Community
Service. Letters should provide biographical information about the nominee.
• Optional letters of support (maximum 3) as well as a nominee resume are welcome.
Please submit a completed nomination form, bio and
letter of support by mail, fax, or email by May 15,
2019 to:
WIND Distinguished Alumni Selection Committee
Wyoming Institute for Disabilities
Dept. 4298
1000 E. University Avenue
Laramie, WY 82071
Fax: (307) 766-2763
Email: wind.uw@uwyo.edu
