Nominee's name (including maiden if applicable):

Nominee's mailing address :

City: , State: , Zip:

Nominees preferred e-mail address:

Nominee daytime telephone:

What award do you recommend your nominee for consideration?
Oustanding Young Alumni
E. Burton Mercier Service
Alumni Achievement
Distinguished Alumni
*Please note, to be considered for a Distinguished Alumni Award, the nominee must have previously been selected for either the Outstanding Young Alumni, E. Burton Mercier Service, or Alumni Achievement award.


Illinois State degree(s) and major(s):

Current position and employer :

Name of person submitting this nomination:


Daytime phone: E-mail address:

Please explain why this nominee should be selected for an Alumni Association Award.



Please list specific accomplishments and service activities that support your recommendation.



Please also complete the biographical data form for your nominee.

Please submit a resume, vita or detailed summary of the nominee's professional experience.

Letters of recommendation may also be submitted.

Stronger consideration will be given to completed nomination files.