Distinguished Alumni Award Nomination Form

Nominee Information

First Name

Last Name

Last Name at Graduation (if it has changed)

Years Attended Penn State New Kensington

Graduation Year

Education/Degrees Acquired from other institutions

Home Address

City

State

Zip Code

Home/Cell Phone

Work Phone

Email Address

Employer

Title

Nature of Business/Profession

Information on Nominee’s family (partner’s name, partner’s profession, children’s names/ages, Penn State legacy family)

Please answer the following questions about the person you are nominating for this award.

Questions

1. What significant contribution has the nominee made to his/her profession or field?

2. What are the nominee’s career accomplishments and achievements?

3. How has the nominee remained connected to Penn State New Kensington?

4. Detail any community service activities with which the nominee has been involved. This includes both leadership roles as well as participation.

Letter of Recommendation

Upload requirements

Optional File Upload 1

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Optional File Upload 2

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Optional File Upload 3

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Optional File Upload 4

Upload requirements

The following 4 questions are about the person you are nominating. Supporting documents for each area, such as newspaper articles, press releases and resumes, are strongly encouraged. These can be uploaded below and submitted with this form, or emailed to [email protected].

Nominator Information

Nominator"s Name

Address

City

State

Zip Code

Daytime Phone

Email Address

Relationship/Connection to Nominee

Please answer these final questions about you, the nominator.

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