Awards Gala Nomination - Stevens Institute of Technology

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Stevens Awards Gala Nomination Form

Nominee Information
Nominator Information
Review

Nominee Information

Nomination Award

Award Category*

Nominee's Name

Nominee Name

First:*

Middle:

Last:*

Please provide information about the candidate to substantiate your nomination. Include distinguished service or achievements, such as offices held, papers published, patents awarded, peer recognition, professional accomplishments, etc.

Please provide references with names and addresses of individuals acquainted with the nominee's record from whom the Awards Committee may seek further information.

Nominee's Address

Address Line:

Address Line 2:

City:

State:

Zip Code:

Country:

Additional Nominee Information:

Email Address:

Phone Number:

Stevens Degree:

Undergraduate

Graduate

Both Degrees

Neither Degree/Friend of Stevens

Undergraduate Class Year:

Graduate Class Year(s):

Is the Nominee aware of this Nomination?

Yes

Summary

Please provide a summary of the Nominee's accomplishments which meet the criteria of this Award

If you would like to submit additional information for your nomination, please email Michelle Nunez, Director of Development and Alumni Events, at mnunez3@stevens.edu.

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