Heritage Honours Award Nomination Form

Heritage Honours Award Nomination Form

<p> ___ Alumni Achievement Award Recognizes the significant professional accomplishments of UNI graduates. </p><p>___ 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.</p><p>___ Alumni Service Award Recognizes graduates who have shown long and continuous service to the university and their community.</p><p>___ Honorary Alumnus Award Presented to a friend of the university in recognition of their exceptional support of the University of Northern Iowa. ------Nominee Information:</p><p>Name ______First Maiden Last</p><p>Address ______</p><p>City ______State ______Zip Code ______</p><p>Daytime Phone ______Evening Phone ______</p><p>Graduation Year(s) ______E-mail Address ______</p><p>Current Occupation ______</p><p>Current Employer ______</p><p>------Nomination submitted by:</p><p>Name ______First Maiden Last</p><p>Address ______</p><p>City ______State ______Zip Code ______</p><p>Daytime Phone ______Evening Phone ______</p><p>E-mail Address ______</p><p>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.)</p><p>Please describe this individual’s involvement with and service to the University of Northern Iowa.</p><p>Return to: UNI Alumni Association 1012 W. 23rd Street Cedar Falls, IA 50614-0284 Fax 319-273-3458</p>

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