Young Alumni Award Nomination Form

Please have all materials and information on hand before beginning this form, as you will not be able to save your progress and return at a later time.

Nominator's Name

Nominator's Email Address

Date of Submission

Your Phone Number

Nominee's Name

Nominee's Affiliation

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Nominee's Graduation Year (MD, PhD, MPH, MS, HS)

Nominee's Current Position and Location

Service: Describe the volunteer's involvement with the School. In what ways have they given service? Service of all kinds is considered (e.g. time spent supporting the mission of the school, active involvement with students in educational or advising activities, providing leadership to other volunteers, spearheading alumni participation in reunion activities, or support of other alumni activities.

Leadership: How has this individual used their talents to influence others in their field? As a volunteer to Geisel? To their community? Describe the path thus far as it relates to their work, accumulated talents, and direction.

Career Accomplishment or Recognition: What are their significant accomplishments thus far that warrant distinction and celebration?

Description of Commitment to the Institution: How have they demonstrated commitment, loyalty, and enthusiasm as a volunteer or as an active alum?

Please attach the Nominee's CV and a letter of recommendation here.

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