UIC College of Medicine Distinguished Alumnus Award
NOMINATION FORM

The Distinguished Alumnus Award is given in recognition of outstanding professional achievement and service to the medical profession, community, the College, and/or the University. This award is presented annually to an alumnus of the College of Medicine who has demonstrated excellence in leadership, professional growth, educational advancement or service. (No posthumous nominations please)

The award recipient will be recognized at the UIC College of Medicine Reunion Dean’s Luncheon on Friday, October 5, 2007. Award recipient must be present at Reunion in order to receive the award.

Distinguished Alumnus Award Nomination Form (PDF)

Your Name :
Class Year :
Your E-mail
Nominee's Name :
Recipient must be from the reunion classes of 1942, 1947, 1952, 1957, 1962, 1967, 1972, 1977 & 1982
Nominee's Class Year :
Nominee's Address (if known)
Street :
City :	State :
Zip :
Phone :
Please state why you have nominated this individual for the Distinguished Alumnus Award:

UIC College of Medicine Distinguished Alumnus Award NOMINATION FORM

UIC College of Medicine Distinguished Alumnus Award
NOMINATION FORM