ULM Service Award
Information and Instructions
Nomination deadline – Thursday, October 3, 2013
_________________________________________________________________________________
About the Award
Since 1997, the ULM Alumni Association has presented the "ULM Service Award" at the Alumni Awards
Reception during Homecoming Week. The Alumni Association is proud to sponsor a program that
recognizes outstanding service by a ULM staff member.
This award recognizes a ULM STAFF MEMBER, who through their efforts, contributes significantly to
the welfare of humanity and the stature of the University of Louisiana at Monroe.
A candidate must be a FULL-TIME ULM STAFF MEMBER who has completed three consecutive years of
service at ULM and who has contributed to the betterment of ULM and the community through
extraordinary service.
Examples of these contributions may include:

Outstanding service to the university or the community which leads to improvement in those areas.

Service to profit, public, or non-profit organizations which improve the economic well being of
individuals or the community served by the university.

Involvement in activities which raise the socio-economic, cultural, or social stature of members of
the community.

Involvement which leads to improvement of the quality of life for individuals and the community.
A Service Award nomination form and documentation outlining the candidate's service experience must be
submitted to the Office of Alumni Relations no later than Thursday, October 3, 2013.
A committee composed of ULM staff and alumni will review the nomination forms and select a recipient.
The recipient will be presented with a plaque commemorating their selection at the Alumni Awards
Reception on Saturday, October 26, 2013.
Remember, you may nominate yourself or nominations may come from any employee on campus.
Nomination Form Instructions
Please read these instructions before proceeding to the nomination form. Reading these instructions
can save you time and may answer any questions you may have.
1. Save the instructions and the nomination form file to your computer (the instructions and nomination
form are in the same file.)
2. Print out these instructions for reference, if needed.
3. Only typed nomination forms will be accepted. If you would like to fill out this nomination form
on your computer, you will need to use Adobe Reader or Adobe Acrobat, version 6.0 or greater.
Click here to download the free Adobe Reader or enter
http://www.adobe.com/products/acrobat/readstep2_allversions.html
into your Web browser. You may also print out the nomination form and type your information using
a typewriter.
NOTE: Please do not submit a hand-written nomination form – only typed nomination forms
will be accepted.
4. A separate nomination form is required for each nominee.
5. Please provide as much detail as possible when completing the nomination form.
6. Remember to sign the nomination form. Unsigned nomination forms cannot be accepted.
7. When the nomination form is complete, print the nomination form, sign the nomination, and mail,
hand-deliver, or fax to:
ULM Alumni Association
ATTN: ULM Service Award
Anna Gray Noe Alumni Center
4400 Bon Aire Drive
Monroe, LA 71203
(318) 342-3620 (fax)
Nomination forms must be postmarked by Thursday, October 3, 2013 or delivered to the ULM
Alumni office no later than Thursday, October 3, 2013.
ULM Service Award
Nomination Form
Please See Instructions for Nomination Deadline
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PERSONAL INFORMATION
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Name: ______________________
(Last)
__________________________
(First)
______________________
(Middle or Maiden)
Department/Position Title: ___________________________________________________________
Work Phone: ___-____
VOLUNTEER ACTIVITY
Years of ULM Service: _____
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Organization Name: ________________________________________________________________
Mailing Address ___________________________________________________________________
City_________________ State___ Zip_________ Contact Name: _________________________
Years of Volunteer Service:_____ Type of Organization:__________________________________
Please describe nominee’s participation and contribution to this organization: _______________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
VOLUNTEER ACTIVITY
-----------------
Organization Name: ________________________________________________________________
Mailing Address ___________________________________________________________________
City_________________ State___ Zip_________ Contact Name: _________________________
Years of Volunteer Service:_____ Type of Organization:__________________________________
Please describe nominee’s participation and contribution to this organization: _______________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
VOLUNTEER ACTIVITY
----------------Organization Name: ________________________________________________________________
Mailing Address ___________________________________________________________________
City_________________ State___ Zip_________ Contact Name: _________________________
Years of Volunteer Service:_____ Type of Organization:__________________________________
Please describe nominee’s participation and contribution to this organization: _______________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
VOLUNTEER ACTIVITY
-----------------
Organization Name: ________________________________________________________________
Mailing Address ___________________________________________________________________
City_________________ State___ Zip_________ Contact Name: _________________________
Years of Volunteer Service:_____ Type of Organization:__________________________________
Please describe nominee’s participation and contribution to this organization: _______________
__________________________________________________________________________________
__________________________________________________________________________________
__________________________________________________________________________________
My signature below attests the information provided in this nomination form is accurate and true to the
best of my knowledge:
______________________________________________________
(signature)
________________________
(date)