Alumni Award Nomination Form
Waynesburg University Alumni Council

Nominee's Information:
Name _____________________________________________
Address _____________________________________________
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Home Phone (____)____________ Work Phone (_____)___________
Email _____________________________________________
Nominee is a graduate of Waynesburg University: Yes _______ No _______
If yes, please provide the following:
Name at time of graduation _____________________________________________
Year of graduation __________
Major _________________ Degree________________
Is the nominee aware he/she is being nominated for an award?Yes_________ No_________
Golden Key - This award recognizes alumni and friends for a lifetime of significant leadership and involvement with the University. Recipients have distinguished themselves among their peers in a meaningful way.
Distinguished Alumnus/a - This award recognizes graduates for their exemplary professional service and/or volunteer accomplishments, as well as a history of involvement with Waynesburg University.
Reason for the Nomination (Include personal, professional, academic, and/or community achievements and service, along with basic biographic information if available. Additional letters of recommendation may be provided, but are optional.) Use this form or attache a separate sheet of paper with the requested information.
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Nominator's Information:
Name _____________________________________________
Address _____________________________________________
_____________________________________________
Home Phone (____)____________ Work Phone (_____)___________
Email _____________________________________________
Best time to reach ____________ #______________________
Designate any affiliation; past or present you have had with Waynesburg University:
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Return this form to the Waynesburg University Alumni Office, 51 W. College Street, Waynesburg, PA 15370. Fax 724-627-3545.

Nomination forms are kept on file and are considered for three years from the date received. Selections are made by a volunteer alumni committee and approved by the Waynesburg University Alumni Council Board of Directors. Presentations are made annually at Alumni Day in June.