Alumni Award Nomination Form

Nominations should be made by May 15, 2025. Alumni, faculty, staff and friends of EIU are welcome to submit alumni award nominations. Any questions, please email Koty Gough at dlgough2@eiu.edu

Today’s Date: Today’s Date: / MM / DD YYYY
Select a Category:

Select a Category: Distinguished Alumna/us Award Louis V. Hencken Alumni Service Award Outstanding Young Alumna/us Award Distinguished Educator Award
Attach one letter of recommendation and any supporting materials such as articles, additional letters, resumes, etc. Additional information may also be emailed to ammay@eiu.edu.

Attach Files
Nominee Information:
Nominee's Name: Nominee's Name: First Last
Nominee's Graduation Year(s):
Nominee's Address: Nominee's Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Nominee's Phone: Nominee's Phone: - ### - ### ####
Nominee's Email:
Nominator Information:
Nominator's Name: Nominator's Name: First Last
Nominator's EIU Affiliation:
Nominator's Graduation Year(s):
Nominator's Address: Nominator's Address:
Street Address Address Line 2 City State / Province / Region Postal / Zip Code Country
Nominator's Phone: Nominator's Phone: - ### - ### ####
Nominator's Email:

Alumni Award Nomination Form

Alumni Award Nomination Form

Nominee Information:

Nominator Information: