Fillable Distinguished Service Alumni Award Nomination Form (Winthrop University)

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Distinguished Service Alumni Award Nomination Form (Winthrop University)

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DISTINGUISHED SERVICE ALUMNI AWARD NOMINATION FORM
03/2019
Nominee Personal Information
Full name of nominee: _______________________________________________________________________
Birthplace: ______________________________________________Date of birth: _______________________
Hometown: ________________________________________________________________________________
Email address: _____________________________________________________________________________
Primary residence address: ___________________________________________________________________
Employer: _________________________________________________________________________________
Business address: ___________________________________________________________________________
Home phone: ______________________________________________________________________________
Business phone: ____________________________________________________________________________
Nominee Family Information
Spouse’s name: ____________________________________________________________________________
Is nominee’s spouse an alumna/us of Winthrop?
Yes No If yes, year of graduation:
Children (please include name and date of birth for each child. If any children are Winthrop alumni, please
include their class year.)
Nominee Education
Degree(s) and graduation year(s) from Winthrop:
Degree(s) and dates of attendance for other institutions:
03/2019
Service to Winthrop as an Alumnus
Alumni Association:
Winthrop Foundation:
Athletics/Eagle Club:
Other areas of service to Winthrop:
Service to Winthrop as a Student
Clubs/Organizations:
Other areas of service to Winthrop:
Civic Accomplishments
Describe specific, significant contributions by the nominee to the local community, state, and nation through
public service:
Describe specific, significant contributions by the nominee to the local community, state, and nation through
civic activities:
Describe specific, significant contributions by the nominee to the local community, state, and nation through
social services:
Describe specific, significant contributions by the nominee to the local community, state, and nation through
religious organizations:
Describe specific, significant contributions by the nominee to the local community, state, and nation through
memberships:
Winthrop Alumni Association
304 Tillman Hall
Rock Hill, SC 29733
803/323-2145
800/578-6545 (Toll-Free)
alumni@winthrop.edu
Offices held in the respective civic, social, religious and community service organizations:
Professional Experience
Present occupation:
Former occupation(s) and dates of employment:
Professional or business-related membership(s):
Professional awards and achievements:
Published articles:
Presentations at conferences/seminars:
Nominator Information
Name: _____________________________________ Email address: _________________________________
Address: __________________________________________________________________________________
Home phone: ___________________ Business phone: __________________ Class Year: ________________
Signature: ___________________________________________________________________________
Letters of recommendation and/or other supporting documentation may be attached.
Nomination forms must be updated and resubmitted if the nominee has been nominated previously.
Submit completed nominee applications via email to Lori Tuttle, executive director of alumni relations and
reunion giving, at tuttlel@winthrop.edu.
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Distinguished Service Alumni Award Nomination Form (Winthrop University)

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Completed 27 July 2020

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