Distinguished Service Award Nomination Form – Clemson Alumni Association

NOTE: The details provided in the nomination form and the support letters are the sole source of information that the committee uses in the evaluation and selection of candidates. Please take this into consideration when determining the extent to which you complete the questions below.

Nomination Form Distinguished Service Award

Full Name of Nominee*
Prefix First Middle Last Suffix
Maiden Name of Nominee
Birthplace of Nominee
Birth Date of Nominee
MM slash DD slash YYYY
Home Town of Nominee
Nominee's Residence Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nominee's Business Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Nominee's Home Phone
Nominee's Business Phone
Nominee's Spouse's Name
Prefix First Middle Last Suffix
Child Name 1
Prefix First Middle Last Suffix
Is this child a current student or graduate of Clemson? If a graduate, what year did they graduate?
Child Name 2
Prefix First Middle Last Suffix
Is this child a current student or graduate of Clemson? If a graduate, what year did they graduate?
Child Name 3
Prefix First Middle Last Suffix
Is this child a current student or graduate of Clemson? If a graduate, what year did they graduate?
Child Name 4
Prefix First Middle Last Suffix
Is this child a current student or graduate of Clemson? If a graduate, what year did they graduate?
Education: Degree(s) and year(s) of graduation from Clemson
Year(s) attended Clemson, if not a graduate:
Degree(s) from other colleges (with dates)
Service to Clemson Alumni Association
Service to Clemson University
Service to Clemson University Foundation
Service to IPTAY/Athletics
Other Clemson Service/Involvement
Civic Accomplishments/Memberships and Offices Held
Describe specific significant contributions by nominee, benefiting the community, state and nation, through public service, civic activities, social services, and membership in civic, social, and other community service organizations.
Community/Civic/Public Service Activities
Professional/Personal Accomplishments
Please describe in detail any personal accomplishments of the nominee that should be taken into consideration by the committee. (Please include homemaker or professional volunteer accomplishments).
Former Occupations
Please describe in detail the nominee’s professional career and any accolades they received that should be taken into consideration by the committee. (Please include long-term careers, virtual or temporary work, homemaker or professional volunteer roles).
Present Occupation
Membership in professional or business related organization(s)
Significant Accomplishments in Chosen Field
Name of Nominator*
Prefix First Middle Last Suffix
Names of additional nominators and their Clemson graduation years
Date of Submission
MM slash DD slash YYYY
Address
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone
Email*
Supporting Materials*
*Three letters of support are required for consideration. If readily available, the nominee's resume may be included as supporting documentation. Nomination packet cannot exceed ten pages in length including these required documents.
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