Heritage Honours Award Nomination Form

___ Alumni Achievement Award Recognizes the significant professional accomplishments of UNI graduates.

___ Young Alumni Award Recognizes graduates 40 years of age or younger who have demonstrated success early in his/her career and who has been active in the life of the university.

___ Alumni Service Award Recognizes graduates who have shown long and continuous service to the university and their community.

___ Honorary Alumnus Award Presented to a friend of the university in recognition of their exceptional support of the University of Northern Iowa. ------Nominee Information:

Name ______First Maiden Last

Address ______

City ______State ______Zip Code ______

Daytime Phone ______Evening Phone ______

Graduation Year(s) ______E-mail Address ______

Current Occupation ______

Current Employer ______

------Nomination submitted by:

Name ______First Maiden Last

Address ______

City ______State ______Zip Code ______

Daytime Phone ______Evening Phone ______

E-mail Address ______

Relationship to Nominee ______(over) Please list the professional and civic accomplishments and achievements of this individual. Please be as specific as possible. (Ex: career highlights, awards received, etc.)

Please describe this individual’s involvement with and service to the University of Northern Iowa.

Return to: UNI Alumni Association 1012 W. 23rd Street Cedar Falls, IA 50614-0284 Fax 319-273-3458