50 YEAR CLUB OUTSTANDING RECOGNITION AWARD
PUBLIC SERVICE AWARD

Nomination Form



Please note that required questions are marked with an asterisk (*).

Section 1

First Name *
   

Middle Initial
   

Last Name *
   

Address: *
   

Telephone Number: *
   

E-Mail Address: *
   

CSU GRAD YEAR (if applicable):
   

Major:
   

College:
   

Non-CSU Degrees/Education:
Identify University and Graduation Year(s)
   

Occupation or Profession:
Current/Retired
   




Section 2

Each question has a size/length limit of 3500 characters, including spaces. Nominations that exceed the size/length restrictions may not receive full consideration.

In order to ensure that responses meet size limitations, we highly recommend that you first type your responses in a Word document (or similar program) and then transfer the responses to this form.

  1. How has the nominee demonstrated leadership skills and exemplary public and/or community service to his or her community? *
[3500 character maximum]
   

  2. How has the nominee provided service to his or her charitable or religious organizations? *
[3500 character maximum]
   

  3. How has the nominee provided service to local, state, or national government? *
[3500 character maximum]
   

  4. How has the nominee provided service to the medical or environmental well-being of humankind? *
[3500 character maximum]
   

  5. How has the nominee provided service to Colorado State University (volunteer roles, board memberships, committees, etc.)? *
[3500 character maximum]
   

  6. List any awards or honors the nominee has received recognition for related to public service. *
[3500 character maximum]
   

  7. Describe the nominee's public service highlights. *
[3500 character maximum]
   

  8. Other accomplishments and nomination information: *
[3500 character maximum]
   

  9. Why do you believe your nominee deserves this award? *
[3500 character maximum]
   

   Additional Notes: *
[3500 character maximum]
   




NOMINATOR INFORMATION

First Name *
   

Last Name *
   

Home Telephone Number: *
   

Work Telephone Number: *
   

Address: *
   

E-Mail Address: *
   




SUPPORTING DOCUMENTS

Please send an email to csualumni@colostate.edu and attach the following:

  1. Up to five letters of recommendation from those who are familair with the nominee's accomplishments and service if available

  2. Up to three supporting documents (i.e. articles, photographs, etc.)

Please indicate the award category and nominee's last name in the subject line.

Choose one:
I am emailing additional supporting documents
I am mailing additional supporting documents

Please note that supporting documents must also be received by the nomination deadline of June 30, 2017 (by 5 p.m. MST)

Submit hard copies of supporting documents to:
    Colorado State University Alumni Association
    50 Year Club Outstanding Recognition Award
    7114 Campus Delivery
    Fort Collins, Colorado 80523-7114
If you see this field, please leave it empty.

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