50 YEAR CLUB OUTSTANDING RECOGNITION AWARD
PUBLIC SERVICE AWARD

2021 Nomination Form - Due May 21, 2021



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

Section 1 - Nominee Information

First Name *
   

Middle Initial
   

Last Name *
   

Address: *
   

Telephone Number: *
   

E-Mail Address: *
   

CSU Graduation Year:
   

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 their community? *
[3500 character maximum]
   

  2. How has the nominee provided service to their 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. Two (2) letters of recommendation from those who are familiar with the nominee's accomplishments and service if available.

  2. Up to two (2) 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 May 21, 2021 (by 5 p.m. MT)

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

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