Distinguished Alumni Award Nomination Form

For questions please call 717-871-7551 or 800-681-1855 or

email: alumni@millersville.edu

You may also attach any accompanying documents.

Deadline: The deadline is March 15, 2024.

Distinguished Alumni Award

A. Nominee Information
Nominee’s Name: Nominee’s Name: First Last
Class Year:
Address:
Address:

Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Home Phone Number: Home Phone Number: - ### - ### ####
Email (if known):
B. Nominator Information
Name: Name: First Last
Class Year (if MU grad):
Address: Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Day Phone: Day Phone: - ### - ### ####
Evening Phone: Evening Phone: - ### - ### ####
Preferred Email:
MUAA Distinguished Alumni Award

This award may be given to any living alumni member who is a graduate of Millersville University and who has been distinguished in such a way to bring honor to the individual, to the University and/or the MU Alumni Association. Nominations for this award may be submitted by any person familiar with the achievements of an individual’s distinguished endeavor.
C. What was the service or professional achievement/contribution to be recognized? (Briefly describe its nature and purpose and the goals achieved.)
D. When was the service or professional achievement performed? Of what duration? Please include specific dates.
E. Where was the service or professional achievement completed (or still active)? Was it rendered to the MU alumni constituency, the state, or nation? (Please include all details.)
F. How was the service or professional achievement accomplished? Qualify the manner in which the service was rendered.
G. Analysis of Achievement: Please include this nomination by assessing the nominee’s achievement in total. Indicate the impact the service had upon the Alumni Association, the University and/or individual. Please include any additional material which will further substantiate the analysis of this service.
Nominator signature:

Draw or Type

I understand this is a legal representation of my signature. Clear

Full Name

I understand this is a legal representation of my signature.
Date: Date: / MM / DD YYYY
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Distinguished Alumni Award Nomination Form

Distinguished Alumni Award

Distinguished Alumni Award

A. Nominee Information

B. Nominator Information

MUAA Distinguished Alumni Award

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