Nomination Form
CSULB DISTINGUISHED ALUMNUS/A AWARD 2014
Presented by the Alumni Association at
The College’s Commencement Ceremony and
The Alumni Awards Banquet: Thursday, May 8, 2014,
Hyatt Regency Long Beach
Please see the separate awards criteria document for the selection process and criteria
details.
Alumnus/a nominee:
____________________________________________________________________________
(last name)
(first name)
(middle)
(former)
Grad year(s): ______________________________________
Major(s):__________________________________________
If the nominee did not earn a CSULB degree but completed a significant amount of coursework
at CSULB, please indicate the number of completed units and years attended.
__________________________________________________________________________
This nominee can be contacted at:
Address: ____________________________________________________________________
City, State, Zip Code: __________________________________________________________
Home phone: _______________________ Work phone: _______________________________
E-MAIL:_________________________________ FAX: ________________________________
Current job title: ______________________________________________________________
Employment location: __________________________________________________________
Since graduation, please describe this nominee’s (may attach additional information on each question):
1.
Accomplishments and recognition in his/her field. Made a significant impact regionally,
statewide, and/or nationally.
2. Proven record of leadership and service to his/her community:
3.
Demonstrated interest, pride and support of CSULB. This could include serving as a
volunteer, contributes as a donor, attends events, and/or stays connected with faculty or
staff (please include the names and their departments):
This nomination is made by:
Your Name: __________________________________________________________________
Address: ____________________________________________________________________
City, State, Zip Code: __________________________________________________________
Phone #: _______________________ E-mail: _______________________________________
Your relationship to the nominee: _________________________________________________
Your signature: ____________________________________ Date: ______________________
Deadline and process:
Please submit this nomination form, resume or bio sketch, and other supporting materials
(i.e. press articles, recommendation letters, etc.) by October 21.
The alumni office will then forward the packet to the appropriate college dean. The dean will
submit 2 to 4 nominees to the Alumni Association Awards Committee by Nov. 1. The Committee
selects the final recipients.
To insure that your packet is received by October 21, 2013, please mail, e-mail, or FAX
packets to:
Mrs. Gay Arakawa, Executive Director
CSULB Alumni Association; 1250 Bellflower Blvd., Long Beach, CA 90840-8101
Gay.Arakawa@csulb.edu; FAX 562.985.5488
For questions, please call Gay at 562.985.5252