Nomination Form

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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/GODA nomination. All nominations must include: • 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 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 • 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: • Providing consultation to the community and government agencies • Speaking and/or making presentations to public groups, organizations, panels and the media • • 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 [email protected]

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