Penn State Harrisburg Alumni Society's Awards Nomination Form

Please fill out the information below.

DEADLINE: JUNE 1ST

Achievement Awards People to Watch
Candidate Name
Home Address
Phone # (Home)
Phone # (Business)
Profession/Occupation
Title
Name of Company
Business Address
Penn State Harrisburg Degree(s)
Major
Education Other Than at Penn State

Business/Professional Honors and Awards:

Community Service, Honors and Awards (include civic, religious, professional, youth, and philanthrophic activities):

Penn State Awards:

Current Penn State activities/involvement/memberships:

Penn State activities as a student:

Memberships or Directorships (other than Penn State):

1.) Please attach a cover letter to support your nomination.

2.) Please provide a copy of the candidate's resume (please limit to four pages), if possible. Nomination form does not have to be completely filled out if resume is attached providing needed information.

3.) Letters of recommendation and/or support may be attached.
Name of Nominator
Phone #
Address
City
State
Zip Code
Date of Nomination

Send Nomination to:

Alumni Relations Office - Penn State Harrisburg
W110 Olmsted Building
777 West Harrisburg Pike
Middletown, PA 17057-4898

Tel: (717) 948-6715
Fax: (717) 948-6317