Distinguished Social Work Alumni Nomination Form

The Department of Social Work is seeking nominations for the 2012 Distinguished Alumni Award. This award is designed to recognize individuals who attended UND and are noteworthy for one or more of these qualities:

• Continued donation of time, talent, resources and enthusiasm on behalf of the Department.
• Significant professional achievements.
• Exemplary leadership in community and professional activities.

Nominations can be made by faculty, alumni and anyone with knowledge of a deserving alumna/alumnus of the University of North Dakota, Department of Social Work. Nomination forms must be submitted no later than September 1, 2012. The recipient will be recognized at the 2011 Annual Social Work Homecoming celebration to be held on Friday, October 12, 2012.

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*Name of Nominee:
Address:		City:
State:		Zip Code:
Phone:		Email:
Detailed Rationale for Nominee:
List of Professional background, accomplishments, service, etc (Nominee's resume preferred):
Nominated by:

If you wish to submit a hard copy of this nomination form, please submit to:

Thomasine Heitkamp, Chair
Department of Social Work
The University of North Dakota
225 Centennial Drive, Stop 7135
Grand Forks, ND 58202