Distinguished Alumni Nomination Form 2024

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 distinguished alumni or emeriti should be for your college for 2024. Please feel free to nominate a deserving individual. One nominee per form only.

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* 1. Your Contact Information

Nominator First Name
*Required

Nominator Last Name
*Required

Email Address

Phone Number

Distinguished Alumni Award (Graduated 1972 to 2018)
A Distinguished Alumni is one who has contributed to their field of study or achieved a record of major distinction in his/her career.

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* 2. Name of the alumnus you are nominating for the Distinguished Alumni Award, (1972 to 2018)

Nominee First Name

Nominee Last Name

Nominee Email Address (if known)

Nominee Phone Number (if known)

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* 3. College the Distinguished Alumnus nominee graduated from (if known)

The College of Arts and Sciences (CAS)

The College of Health and Human Services (CHHS)

The College of Business (COB)

The College of Education and Human Development (CEHD)

Other (please specify)

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* 4. Graduation year for the Distinguished Alumnus nominee (if known)

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* 5. Why do you believe this person should be recognized as a Distinguished Alumni during Homecoming 2024? Please reference specific outstanding career & professional achievements; activities or other involvement in the community, college, and/or university; professional service, awards, or recognitions.

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* 6. Please rate your Distinguished Alumni nominee based upon your knowledge of this individual (1 is the lowest and 5 is the highest):

	1	2	3	4	5
Demonstrated success in career	Demonstrated success in career 1	Demonstrated success in career 2	Demonstrated success in career 3	Demonstrated success in career 4	Demonstrated success in career 5
Demonstrated work in the community	Demonstrated work in the community 1	Demonstrated work in the community 2	Demonstrated work in the community 3	Demonstrated work in the community 4	Demonstrated work in the community 5
Educational achievement	Educational achievement 1	Educational achievement 2	Educational achievement 3	Educational achievement 4	Educational achievement 5
Prior awards and recognition	Prior awards and recognition 1	Prior awards and recognition 2	Prior awards and recognition 3	Prior awards and recognition 4	Prior awards and recognition 5

Rising Star Alumni Award (Graduated 2019 to 2024)
The Rising Star Alumni award recognizes a graduate from the last five years only, for superior accomplishments. Any graduate of one of the four colleges is eligible for nomination.

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* 7. Name of the Rising Star Award Nominee (2019 to 2024)

Nominee First Name

Nominee Last Name

Nominee Email Address (if known)

Nominee Phone Number (if known)

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* 8. College the Rising Star Alumni Nominee Graduated from (if known)

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)

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* 9. Why do you believe this person should be recognized as a Rising Star during Homecoming 2024? Please reference specific outstanding career & professional achievements; activities or other involvement in the community, college, and/or university; professional service, awards, or recognitions.

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* 10. Please rate your Rising Star nominee based upon your knowledge of this individual (1 is the lowest and 5 is the highest):

	1	2	3	4	5
Demonstrated success in career	Demonstrated success in career 1	Demonstrated success in career 2	Demonstrated success in career 3	Demonstrated success in career 4	Demonstrated success in career 5
Demonstrated work in the community	Demonstrated work in the community 1	Demonstrated work in the community 2	Demonstrated work in the community 3	Demonstrated work in the community 4	Demonstrated work in the community 5
Educational achievement	Educational achievement 1	Educational achievement 2	Educational achievement 3	Educational achievement 4	Educational achievement 5
Prior awards and recognition	Prior awards and recognition 1	Prior awards and recognition 2	Prior awards and recognition 3	Prior awards and recognition 4	Prior awards and recognition 5

Distinguished Faculty Emeritus/Retiree Award
The Distinguished Faculty Emeritus/Retiree Award recognizes a retired GSU faculty or staff member who continues their extraordinary commitment to their community and Governors State University demonstrated through service and distinction.

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* 11. Name of the Distinguished Faculty Emeritus/Retiree Award Nominee

Nominee First Name

Nominee Last Name

Nominee Email Address (if known)

Nominee Phone Number (if known)

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* 12. Why do you believe this person should be recognized as a Distinguished Faculty Emeritus/Retiree Award nominee for Homecoming 2024? Please reference specific outstanding career & professional achievements; activities or other involvement in the community, college, and/or university; professional service, awards, or recognitions.