Fillable Distinguished Alumni Nomination Form-fillable Distinguished Alumni Nomination Form

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Distinguished Alumni Nomination Form-fillable Distinguished Alumni Nomination Form

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Rising Star Award – This award recognizes a graduate of the past ten years who is on the rise in his/her
career field. The successful candidate should exhibit the potential for significant professional achievement
and leadership ability, promise for continued success, and set an inspirational example for future alumni.
Professional
Achievement
Award
–
This
award
recognizes
a
graduate
who
demonstrates
sustained
(ten
years
or
more)
success
in
professional
life
and
leadership
within
his/her
profession.

The
successful
candidate
should
exhibit
professional
growth,
leadership
abilities,
and
have
achieved
recognition
for
success.

Jeffersonian
Award–
This
award
recognizes
a
graduate
who
demonstrates
a
dedication
to
service
on
a
local,
state,
national,
or
international
level.

The
successful
candidate
will
have
a
history
of
volunteerism,
civic
involvement,
humanitarian
undertakings,
or
service
to
Jefferson
Community
College.

Community
Service
Award
–
This
award
recognizes
a
member
of
the
campus
community,
either
through
employment
or
significant
service
on
college
leadership
or
advisory
boards,
who
meets
all
requirements
for
the
Jeffersonian
Award
but
is
not
a
graduate
of
Jefferson.
Unsure?
–
Allow
the
committee
to
determine
the
category
that
best
fits
the
nomination
materials
provided.
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To nominate an individual for a Distinguished Alumni
Award, complete and submit this form and your letter of
recommendation to: Jefferson Community College
Foundation, 1220 Coffeen Street, Watertown, NY 13601.
You may also
fax your nomination to (315) 786‐0158 or email to
alumni@sunyjefferson.edu. Awards are considered in the categories l isted below.
Please check the category you feel best fits your nominee. For more information, contact the Foundation at (315)
786‐2458.
NOMINEE
First Name Mi Last Name
Previous Name Graduation year
(if different when at JCC)
Address
City State Zip
Daytime Telephone Email Address
Additional Degrees Earned/Institutions Attended
Occupation Job Title
Employer Years in Position
Address
City State Zip
Telephone Number Email Address
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Please describe how the nominee has made a contribution to his/her profession. Include professional
memberships, affiliations, publications, special honors, recognitions, and research. (Feel free to attach no more
than one additional typed sheet.)
Please describe how the nominee has made a contribution to his/her community. Include names of civic, service,
and philanthropic organizations for which the nominee has volunteered or served, the nature of service, and the
years involved. (Feel free to attach no more than one additional typed sheet.)
OPTIONAL INFORMATION
You may submit no more than three (3) additional documents (such as letters of support, newspaper or magazine
clippings, or nominee’s resume) supporting this nomination. Please do not include original materials as they will
not be returned.
Check here if additional materials are enclosed.
YOUR INFORMATION
Mi
Last
State
Email Address
Zip
First Name
Address
City
Daytime
Telephone
Relationship
to nominee
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Distinguished Alumni Nomination Form-fillable Distinguished Alumni Nomination Form

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Completed 3 November 2019

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