Alumni Awards Nomination Form

Check the award for which you are submitting a nomination (self-nominations accepted)

Outstanding Alumni Award

Alumni Achievement Award

Distinguished Service Award (can be graduate or friend of Penn State Altoona)

Honorary Alumni Award

Candidate Information

Candidate Name

Home Address

Home City

Home State

Home Zip Code

Home Phone

Candidate Business Information

Profession/Occupation

Title

Name of company/organization

Business Address

Business City

Business State

Business Zip Code

Business Phone

Education Information

Penn State Degree(s)

Major

Education other than at Penn State

Business/professional accomplishments, honors, and awards:

Community service activities, leadership, honors, and awards:

Current Penn State activities, involvement, and memberships:

Please include additional information/narrative which supports this nomination:

Nominator Name

Nominator Address

Nominator City

Nominator State

Nominator Zip Code

Nominator Email

Nominator Daytime Phone

Penn State Altoona's #GivingTuesday campaign enriches campus, student experience