<p> SAINT LOUIS UNIVERSITY SCHOOL OF MEDICINE ALUMNI MERIT AWARD NOMINATION FORM</p><p>Purpose: The President and administrative officers of Saint Louis University established the Alumni Merit Award to bring to the attention of the community and the nation in a dignified and dramatic way the end-product of the University's diverse, well-rounded educational program - namely its distinguished graduates.</p><p>Award Criteria: Any alumnus/a who exemplifies in his/her daily life the mission of Saint Louis University. These men and women shall have achieved outstanding success: </p><p> in their civic leadership or social welfare activities (include offices held in Civic, Fraternal, Political or Labor Groups);  or in their professional life;  or in their intellectual or cultural pursuits (list memberships in Learned or Cultural Societies, articles published, books written, etc.);  or demonstrates continued interest and evidence of support toward the enhancement of Saint Louis University.</p><p>Note: Full-time Saint Louis University faculty are not eligible to receive the Alumni Merit Award. However, full-time faculty who are at the point of retirement or have already retired are eligible.</p><p>Nominating Candidates: Any person may recommend an alumnus/alumna for the Award. The nomination should contain a complete biographical sketch or profile of the person, together with the salient reasons why the nominee qualifies for this unique recognition. </p><p>Presentation of the Award: The recipient of the award must accept the award in person during the Medical Alumni Reunion Weekend held each year in October. ______</p><p>I (we) recommend the following Alumus/a to the Medical Alumni Association for consideration for the Alumni Merit Award:</p><p>Please print or type. Name: ______first name middle initial last name</p><p>Home Address: ______</p><p>______</p><p>Business Address: ______</p><p>______</p><p>Phone: (Home) ______(Business): ______</p><p>E-mail: ______11/ 2014 Education and degrees received from Saint Louis University:</p><p>School/College of ______Degree ______Year Rec'd ______</p><p>School/College of ______Degree ______Year Rec'd ______</p><p>School/College of ______Degree ______Year Rec'd ______</p><p>Date of Birth: ______Birthplace: ______</p><p>Family Information: (Name of spouse, years of marriage, names and ages of children) ______</p><p>Please briefly describe nominee's accomplishments demonstrating the criteria noted above and provide details of how the nominee exemplifies in his/her daily life the mission of Saint Louis University. ______</p><p> Please include a complete biographical sketch, CV, resume, etc.  If available, please attach any letters of recommendation.</p><p>The above data are fair and accurate statements of facts concerning the above nominee.</p><p>Submitted by: ______first name middle last name Signature: ______</p><p>Address: ______</p><p>Phone: ______E-mail: ______</p><p>Date Submitted: ______</p><p>Nominations accepted via e-mail, fax or mail no later than April 15, 2015. Nominations must be mailed to the attention of Cheryl Byrd at: Saint Louis University, Medical Center Alumni Relations, 3545 Lafayette Avenue, Room 609, St. Louis, MO 63104. Nominations also accepted via e-mail to [email protected] or by fax to 314-977-7880 11/ 2014</p>