2016 Distinguished Alumni Fellow Program
Nomination Form

Submission Deadline: Thursday, March 31, 2016

Selection Criteria and Recipient’s Responsibilities:

  • All candidates must have attended the University of Pittsburgh.
  • Candidates will be evaluated on the basis of their:
  • Outstanding level of professional achievement (emphasis on candidates with national and/or international prominence).
  • Service to the community.
  • Candidates must have received their school/college’s highest alumni award.

Nomination Process:

  • Nominations will be sought from all segments of the University community.
  • It is recommended that candidates not be informed that they have been nominated for this award.
  • In addition to the nomination form, the awards committee will accept supporting documents (sent to the address below) for consideration such as: news clippings, resume, CV, etc. if they can be acquired without notifying the nominee.

Selection Process:

  • The Alumni Association Awards Committee will review all nominations and submit the top five candidates to the chancellor, provost and vice chancellor for institutional advancement for the final decision. The chancellor, provost and vice chancellor for institutional advancement have the prerogative to consider others than the finalists selected by the awards committee. All those involved in the selection process will hold the names of all nominees in confidence.
  • The finalists must be able to attend and participate in the Distinguished Alumni Fellows Dinner, which will be held during Homecoming.

Gary Pollock
Alumni Relations 4227 Fifth Avenue, Ste. 140, Pittsburgh, PA 15260
Phone: (412) 624-8229, FAX: (412) 624-8288
E-mail:

Please complete the following form. You have two options for submission; you can print this form out, complete the fields manually, and then fax a copy to 412-624-8288 Attn: Gary Pollock ORyou can complete the form fields and attach an electronic copy to an e-mail and send it to:.

Complete the following steps If you are submitting electronically:

  1. Complete this form and select File > Save As from the menu. When saving the copy, save it with the name of the nominee in the file name (2016_daf_form_chrissmith.pdf (or doc).
  2. Compose a message in e-mail to Gary Pollock at and send the saved document as an attachment.
  3. If you wish to submit any additional documents (such as a biographical sketch, resume, c.v., article, etc.,) you can attach them to the email, fax them as instructed above, or send them toGary Pollock’s attention at the address listed on the bottom of the first page.

Nominee’s Name:
Title:
Company/Employer:
Address:
Daytime Telephone:
E-mail Address:
University of Pittsburgh Degree(s):
Additional Degree(s):
Nominator’s Name:
University Affiliation:
Daytime Telephone:
E-mail Address:
Professional Achievement:
Describe the nominee’s outstanding achievement:
Community Service/Volunteer Involvement:
Please comment on nominee’s service to the community:

Submission Deadline: Thursday, March 31, 2016

 Check if you plan to submit supporting documentationwith your nomination. (Not required)

Note: Supporting documentation includes Curriculum Vitae, Resumes, News Releases, etc.,. Please return as instructed above. Thank you.

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