Distinguished Alumni Nomination Form Distinguished Alumni Award Nomination Nominee Name: Nominee Street Address: Nominee City, State, Zip: Nominee Telephone: Nominee Email: Loyalsock Township School District Graduating Class of: Nominee Employer/Location Nominee Occupation/Title Nominator Name: (Self-nomination is permitted.) Nominator Phone Number: (Self-nomination is permitted.) Nominator Email: (Self-nomination is permitted.) 1. Please explain why the Nominee deserves The Loyalsock Township School District Distinguished Alumni Award. 2. Discuss how the nominee displays leadership and has an impact in their field. 3. Expound upon the nominee’s community involvement. 4. Describe the impact that the nominee has had outside of the community (i.e. at a national level or beyond). 5. Explain multiple ways in which the nominee has positively impacted or provided services for the lives of others. 6. Explain the professional achievements of the nominee. This can include specific training or other unique successes. 7. Discuss how the nominee exhibits an exceptional level of personal integrity, serves as a role model, and displays exemplary values. 8. List and/or explain any awards and/or media notoriety the nominee has earned for their work. 9. Additional comments for consideration. Submit If you are human, leave this field blank.
