Distinguished Alumni Nomination Form

Thank you for taking the time to nominate an individual for a Distinguished Alumni Award, Rising Star Award and/or Distinguished Emeritus/Retiree Award. Please provide answers to the following questions so that our committees may determine who the honorees should be for your college for 2025. One nominee per submission only.
* required

Your Contact Information *

Nominator First Name *

Nominator Last Name *

Nominator Email Address*

Nominator Phone Number*

Birthdate

Why we ask for your birthday: Your birthday helps us match you to your profile irrespective of changes to your postal and email addresses

Please select your connection to Governors State University

Select all that apply

Please describe

Nomination Type *

Distinguished Alumni Award (Graduated 1972 to 2019)

Rising Star Alumni Award (Graduated 2020 to 2025)

Distinguished Faculty Emeritus/ Retiree Award

Distinguished Alumni Award (Graduated 1972 to 2019)

Rising Star Alumni Award (Graduated 2020 to 2025)

Distinguished Faculty Emeritus/ Retiree Award

Nominee First Name *

Nominee Last Name *

Nominee Email Address (if known)

Nominee Phone Number (if known)

College the nominee graduated from.*

College of Arts and Sciences (CAS)

College of Health and Human Services (CHHS)

College of Business (COB)

College of Education and Human Development (CEHD)

Other (please specify)

Unknown

Other College:

A GovState Distinguished Alumnus is a person who exemplifies outstanding career and professional leadership, substantial community impact, and continued advocacy for uplifting others.

A GovState Distinguished Faculty Emeritus/Retiree is a person who continues their extraordinary commitment to their community and Governors State University through service, distinction, and advocacy.

The Rising Star Alumni is a recent graduate (within the last five years) who has achieved superior accomplishments.

Please describe why you believe this nominee exemplifies the qualities worthy of a GovState Distinguished Alumnus.*

Please describe why you believe this nominee exemplifies the qualities worthy of a GovState Distinguished Emeritus or Retiree.*

Please list the nominee's outstanding career and professional achievements. This could include awards and notable recognitions.

Please describe the nominee's community impact.

Is there anything else you would like to share about this nominee?

Agreement

Please keep my nomination anonymous.

I understand that any of the information provided here may be used in media or marketing materials, including direct quotes or otherwise.
I verify that the information I have provided is correct to the best of my knowledge. *

Yes

Please type your first and last name: *