2015 GALLERY OF DISTINGUISHED ACHIEVERS
Nomination Form
Saint Louis School
Nominator’s Full Name:__________________________________________________________________
Nominator’s Address:___________________________________________________________________
Nominator’s Email Address: ______________________________________________________________
Nominator’s Phone: _________________________________________________
Nominee’s Full Name:
Mr. /Mrs. /Ms./Other:___________________________________________________________________
Home Address:
___________________________________________________________________________
Business Address:
__________________________________________________________________________
Email Address:
___________________________________________________________________________
Phone: _________________________________________________
Alternate Phone: _________________________________________________
Occupation / Job Title:
_____________________________________________________________________
Employer:
_______________________________________________________________________________
Education Information:
Please list all degrees earned by nominee.
Year graduated from Saint Louis School______________
Degree Major Year Institution
_________________________ ____________________ __________ ____________________________
_________________________ ____________________ __________ ____________________________
_________________________ ____________________ __________ ____________________________
Nomination Instructions
Nominations can be mailed in, delivered in person, or submitted online at saintlouishawaii.org/GODAnomination. All nominations must include:
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Completed nomination form
Including write up of the three nominee qualifications to be evaluated: Accomplishments,
Service to Saint Louis School, and Service to the Community. No more than six pages total. We will
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•
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• evaluate nominees using only information provided within that six-page limit.
Nominee Qualifications
1.
ACCOMPLISHMENTS
Please indicate accomplishments, whenever possible, documented by awards or recognition received. This category includes, but is not limited to:
Officer or board member of a professional society
Attainment of a position(s) held in high regard (senior or otherwise) in a profession
Outstanding or widely recognized contribution(s) to a profession
Record of published material

2.
SERVICE TO Saint Louis
Please indicate service performed that has benefited or benefits students, faculty, alumni and the
Saint Louis community. This category includes, but is not limited to:
• Service as an advisor or consultant to Saint Louis students or a Saint Louis organization
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Participation in Saint Louis committees or projects
Providing services/support to Saint Louis Schools
3.
SERVICE TO THE COMMUNITY
Please indicate service performed that has benefited or is benefiting the community beyond the Saint
Louis community. If possible, indicate positions held and corresponding dates, as appropriate. This category includes, but is not limited to:
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•
Providing consultation to the community and government agencies
Speaking and/or making presentations to public groups, organizations, panels and the media
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Serving as an officer or board member of a registered service organization
Conducting conferences, workshops or events for the benefit of the community
Nominees must be living and have attended or graduated from Saint Louis School.
Selection will be based primarily on materials submitted by nominator.
All nomination materials, whether paper or electronic, must be received by, postmarked by, or computer time stamped by 5 p.m. (HST) Friday, March , 2015. Submissions received, postmarked or submitted online after the deadline will not be considered. Nominations can be sent to the following:
Mail: Saint Louis School - Gallery of Distinguished Achievers
3142 Waialae Ave.
Honolulu, HI 96816
Online: Saintlouishawaii.org/goda-nomination
If you have any questions, contact Saint Louis at 808 739-4747 or email events@saintlouishawaii.org.