DISTINGUISHED SERVICE AWARD NOMINATION 2024

Title

First

Middle

Last

Suffix

Degree

Address

Address 2

City/Town

State/Province

ZIP/Postal Code

Country

CANDIDATE'S DATE OF BIRTH

CANDIDATE'S BIRTHPLACE

CANDIDATE'S OCCUPATION / EMPLOYER

CANDIDATE'S FAMILY

List spouse's name (maiden name for ladies) and children's name(s). Indicate if spouse attended MSU.

CANDIDATE'S EDUCATION

List name(s) of school/college/university, degree, and year graduated or attended if did not graduate.

Also, list organizations (with offices held) and awards and honors received while at the school(s) listed above.

CANDIDATE'S RECORD OF SERVICE

List the candidate's volunteer service to the local alumni chapter/club, a council or volunteer network, the Alumni Association, and Mississippi State University. Be as specific as possible concerning dates of service, offices held, committee membership, etc.

IMPACT OF SERVICE TO THE CHAPTER

How has this candidate’s service positively benefited and impacted the local alumni chapter/club, a council or volunteer network, and thus the Alumni Association and Mississippi State University? What sets this candidate apart from all other volunteers?

CANDIDATE PHOTO

One file only.
50 MB limit.
Allowed types: gif, jpg, jpeg, png.

ADDITIONAL DOCUMENTATION

One file only.
50 MB limit.
Allowed types: txt, rtf, pdf, doc, docx, odt, ppt, pptx, odp, xls, xlsx, ods.

ADDITIONAL INFORMATION ABOUT THE CANDIDATE

Provide information which will be beneficial to the candidate's nomination, such as outstanding traits, actions or deeds.

NOMINATOR'S STATEMENT:

NOMINATOR'S SIGNATURE

I am pleased to nominate this candidate for the MSU Alumni Association's Distinguished Service Award.

(sign below)

NOMINATOR: Class year or year(s) attended MSU (if applicable)

Name

Phone