Distinguished Alumnus Award Nomination Form | UAMS College of Health Professions

Please use the form below to nominate someone for the UAMS College of Health Professions Distinguished Alumnus Award.

The nomination deadline each year is April 1.

The award is presented during the annual UAMS Alumni Event sponsored by UAMS Institutional Advancement which occurs most often in early June. More information on the event will be available.

Eligibility

Nominees must:

Have earned a certificate or degree from UAMS in a College of Health Professions program
Have demonstrated significant professional achievement and service to their community, profession, industry and / or the college
Be currently working or retired
Not be a current member of the University of Arkansas Board or its affiliates
Not be currently running for local, state or national elected office

Please note: An individual may receive this award only once for the same accomplishments.

Nominee Information

Nominee's Name(Required)

First Last

Nominee's Address(Required)

Street Address Address Line 2 City State ZIP Code

Nominee's Email(Required)

Nominee's Phone Number(Required)

Nominee's Graduation Year(Required)

Nominee's Degree Awarded (A.S., B.S., M.S., etc.)(Required)

Nominee's CHP Program(Required)

Nominator’s Information

Nominator's Name(Required)

First Last

Nominator's Address(Required)

Street Address Address Line 2 City State ZIP Code

Nominator's Email(Required)

Nominator's Phone Number(Required)

Letter Submission

Please upload a Letter of Nomination highlighting the nominee’s distinctive contributions in each area below:

Nominee’s Most Notable Professional Achievements
Nominee’s Most Notable Contributions in Service to the Community and/or Profession/ Industry
Demonstrated interest in and support of the College of Health Professions

File(Required)

Max. file size: 15 MB.