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ALUMNUS SUMMA LAUDE DIGNATUS AWARD

Please fill out the following form to nominate someone for the Alumnus Summa Laude Dignatus Award.

Nominee Information

Nominee Name:
Class Year (of first degee if more than one):
Mailing Address:
City:
State/Province:
ZIP/Postal Code:
Country (leave blank if U.S.):
Phone Number:
Please explain why you feel this nominee should receive the University of Washington's Alumnus Summa Laude Dignatus Award:

Your Information

Your Name:
Mailing Address:
City:
State/Province:
ZIP/Postal Code:
Country (leave blank if U.S.):
Phone Number:
E-mail Address:

Supporting documents for your nominee (curriculum vitae, copies of newspaper clippings, publications, etc.) should be sent under separate cover by January 15, 2010 to:

Courtney Acitelli
UW Alumni Association
4333 Brooklyn Ave NE
Seattle WA 98195

Questions?
Please contact Courtney Acitelli at 206-543-0540 or acitelli@u.washington.edu.

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