Nomination Form

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Nomination Form

As an LSUSD alumnus, student, faculty/staff member, or friend, you are encouraged to nominate someone to receive the Alumnus of the Year Award!

Alumnus of the Year Award
This award is bestowed annually on Alumni Day to recognize an alumnus or friend who has distinguished themselves through career achievements, by making a significant contribution to society in the field of dentistry, or who has given of their time, talents and resources to further the school's mission of education, patient care or research. Deadline for the 2008 Alumnus of the Year Awards nominations is September 1, 2008.

How to Nominate
Complete and submit this form along with one or two paragraphs stating why your nominee should receive the Alumnus of the Year Award. Be as specific as possible; include anecdotal stories, examples of excellence and descriptions of achievements. All nominations are confidential and are reviewed by the LSUSD Alumni Association Nominations Committee.

Nominee
Alumnus of the Year Award Honorary Alumnus of the Year Award (for non-alumni friends of LSUSD)
Name
Class Year
Address
City
State
Zip
Country
Telephone
Fax
E-mail

Is this nominee aware of your nomination? Yes No

Why this nominee deserves the Alumnus of the Year Award:

Nomination Submitted By
Name
Class Year
Address
City
State
Zip
Country
Telephone
Fax
E-mail

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