Distinguished Service Award

The Distinguished Service Award is awarded annually to an individual who:

is an alumnus/alumna, faculty, staff or student of NEOMED, or who is a colleague or friend to the University
through his or her time and talents, has made a significant impact on NEOMED as a result of dedication to teaching, mentoring, volunteering or working for NEOMED. (Preferred nominees will have exemplary service to a variety of aspects of the NEOMED community.)

Name*
Prefix First Last Suffix
Phone*
Phone number is collected in case the committee has questions or needs additional information.
Email*

Email address is collected in case the committee has questions or needs additional information.
Nominee*
Prefix First Last Suffix
Does this individual know he or she is being nominated?*
- Yes
- No
Please list the areas in which the nominee serves NEOMED and our students:*
Briefly describe why the nominee is deserving of the Distinguished Service Award:*
Upload Nominee CV
Accepted file types: pdf, doc, docx, Max. file size: 31 MB.
Not required but you may choose to include.
Upload Letter of Recommendation
Accepted file types: pdf, doc, docx, Max. file size: 31 MB.
Not required but you may choose to include.
Upload References
Accepted file types: pdf, doc, docx, Max. file size: 31 MB.
Not required but you may choose to include.
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Email
This field is for validation purposes and should be left unchanged.

Carrie Circosta
Senior Director, Alumni Relations and Major Gifts
330-325-6664
alumnioffice@380cebbe0d.nxcli.io