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Distinguished
Alumni
Nomination
Form
Submit
by 2/1/2009 for 2009 Distinguished Alumni Award Consideration
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I would like to
nominate the following person . . . |
First Name
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Last name
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Credentials (if
known)
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Other Names used if
different from above (Maiden name, for example)
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Program from
which Candidate Graduated |
Year Graduated from
UW Program (if known)
If graduated from more than one program, please notate that if
known.
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Program from which
candidate graduated (if known - i.e., MS FNP, MS EDUC, BSN,
RN/BSN)
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ADDRESS of
Candidate |
Street/Box
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City
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State
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ZIP
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PHONE & EMAIL
ADDRESS for Candidate
type
w/o dashes (example:1234567890) |
Current Phone
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Email
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RECOMMENDATION
LETTER |
Please type in the
text box below your recommendation letter, which must support at
least one of the following criteria:
- Contributions
to the nursing profession, including excellence in clinical
practice, education, administration, and research
- Outstanding
contributions to the community
- Leadership in
professional organizations
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Your Name &
Relationship to Candidate: |
First Name
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Last name
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Relationship to
Candidate
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Your ADDRESS |
Street/Box
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City
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State
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ZIP
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Your PHONE & EMAIL
ADDRESS
type
w/o dashes (example:1234567890) |
Phone
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Email
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THANK YOU! |
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Thank you so much for
taking the time to nominate this individual. Our Distinguished Alumni
Committee will be reviewing nominations for the 2009 Distinguished
Alumni in February of 2009. Deadline for submission, FEBRUARY 1, 2009. |
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Once our department finds
your nomination in our database, we will email you to
confirm receipt. If you do not receive an email from our
department after 5 days, please email us (nurs.inq@uwyo.edu) to make
sure we have received your information.
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