Nominee Information

First Name

Last Name

Class Year

Address Line 1

Address Line 2

City

State

Postal Code

Home Phone

Work Phone

Employer & Job Title

Length of employment and general duties

Does this individual know that he/she is being nominated for this award?

YesNo

Please complete each of the following four questions completely.

Describe how the nominee’s professional, civic, or charitable efforts have resulted in a change for the better in signi cant situations, institutions, movements or fields of endeavor.

How do the nominee’s activities demonstrate irreproachable character and outstanding citizenship?

Describe any other activities or accomplishments that may demonstrate how this nominee brings distinction to them self, their community or to Bradley University.

What do you see as the single most outstanding achievement that makes this nominee deserving of this award?

Supporting Documents

A maximum of three (3) supporting documents will be considered (e.g. letters, publications, resumes, etc.).

File #1

File #2

File #3

Contact Information