Nomination Form

The priority deadline for Outstanding Service Award nominations is May 1.

Please complete all required fields below.

Nominee's information
Please provide the information for the nominee.
Name*
First Last
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email address*
Preferred daytime phone number*
Nomination information*
Please describe in detail why you believe your nominee is worthy of the UWO Alumni Outstanding Service Award.
Nominator's information
Please provide your information in this section
Nominators name*
First Last
Relationship to nominee
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code
Email address of Nominator*
Preferred daytime phone number*
Alternative phone number

Nominee's information