Willamette University Alumni Citation

Nomination Form

Submit a nomination by filling out the form below.

If you have questions or comments, contact the Office of Alumni and Parent Relations.

Note: Field Names in Red are Required.

Nominee Information

Name*
Degree/Year
Address
Phone
Email
Occupation/Profession
Business Title

Award

I wish to nominate this person for the following award:* Distinguished Alumni Award
Lestle J. Sparks Medallion
Young Alumni Leadership Award
Please provide specific examples of how the nominee has made a difference at Willamette (i.e. participation on boards and committees, volunteerism, philanthropy)
Please provide some detail on the nominee's professional involvement
Honors and accolades the nominee has received:
Charitable actives the nominee is involved in:
How does the nominee's work/or accomplishments reflect the value of his/her Willamette education?
Please provide links to web pages where additional supporting information about the nominee can be found:
Please provide any additional information you believe illustrates that this individual is deserving of award recognition
Additional documentationAttach any additional documents, including the nominee's curriculum vitae, resume, letters of recommendation, magazine or newspaper clippings, or relevant articles.

References

Please provide names and contact information of others who are in support of this nomination. References are optional.
Ref 1 - Name
Class Year
Phone
Email
Affiliation
Ref 2 - Name
Class Year
Phone
Email
Affiliation
Ref 3 - Name
Class Year
Phone
Email
Affiliation

Your Information

Name*
Class Year
Phone
Address
Email*
Please select your affiliation: