Alumni & Giving Back

Pharmacy Alumni Award Nomination Form

Please fill out the below form to nominate an individual for a Pharmacy Alumni Award. Nominations may remain anonymous if you wish. If possible, please send a copy of the nominee's resume or CV to the Pharmacy Alumni Office via e-mail or postal mail. If you do not have access to the individuals resume or CV, the Pharmacy Alumni Office will work to obtain it. If you do not know the answer to a question asked below, just leave that field blank. Thank you for taking the time to nominate an alumnus for this special recognition.

Your Name:

 

Your Year of Graduation:

 

Your E-Mail Address:

 

Your Phone Number:

 

Nominee's Name:

 

Nominee's Year of Graduation:

 

Nominee's E-Mail

 

Nominee's Phone Number:

 

Nominee's Current Place of Employment & Title:

 
Please select the award you are nominating the individual for. Individuals may be considered for more than one award. To select multiple awards, hold the control key down on your keyboard and select the awards you wish to nominate the individual for. For a list of award requirements, please visit the Pharmacy Alumni Awards page http://www.uic.edu/pharmacy/alumni/awards.php.

Please select the award(s) you wish to nominate the individual for:

Please explain why you are nominating the above individual. There is no length requirement; however, the more information you provide helps the Alumni Awards Committee make a better and more informed decision.

Reason for Nominating Individual:
Form Builder WebTool created by the Office of Web Services