University of Rochester Medical Center
University of Rochester Medical Center Home School of Medicine and Dentistry
About the School

Alumni Awards - Nomination Form

It is understood that the information presented on this form will be treated confidentially in its use by the Alumni Awards Committee and the School of Medicine and Dentistry Alumni Relations Office and that any decision made by the Committee, will be final. Please call 800-333-4428 with questions or concerns.

All forms must be submitted to the SMD Alumni Relations Office by March 15.

Choose an award for this nomination:

Distinguished Alumni Award (2010)
Alumni Service Award (2009)

Humanitarian Award (2009)

Nominator Information

First Name:

Middle Initial or Maiden Name:

Last Name:

School of Medicine and Dentistry Degree:

Graduation Year:

Mailing Address:

City:

State:

Zip:

Your link to the nominee:
----------

Nominee Information

First Name:

Middle Initial or Maiden Name:

Last Name:

School of Medicine and Dentistry Degree:

Graduation Year:

City:

State:

Phone Number:

Email:
----------

Reasons for Nomination

I.e., professional accomplishments, service to the community and/or School of Medicine and Dentistry, service to the poor and underprivileged, other considerations:

----------

Education

Advanced Degree   Year
Name of Institution

Other degrees beyond bachelors   Year
Name of Institution

----------

Employment

Employer

Occupation

Title

----------

What do you consider the nominee's most important achievements?

----------

The nominating process requires:

  • A completed nominating form
  • Curriculum Vitae of nominee
  • 2-3 Letters of support from University of Rochester alumni or others
  • Selected samples of writings by nominee, articles about nominee, or other information that will inform the committee

Nominations can also be sent via email to alumni@admin.rochester.edu or mail forms to:

University of Rochester
School of Medicine & Dentistry
Alumni and Advancement Center
300 E. River Road, P.O. Box 278996
Rochester, New York 14627-8996

Questions? Please call the School of Medicine and Dentistry Alumni Relations Office at 800-333-4428.