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Alumni Council Award 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.

Award Name:


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Additional Education

Present Profession

Nominator Information

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In addition to completing the above form, the nominating process requires the following additional materials:

  • Curriculum Vitae of nominee, summarized into a maximum of two pages. (If providing award information, please only submit the number awarded).
  • Maximum two letters of support from University of Rochester alumni or others
  • Maximum three additional documents, such as selected samples of writings by nominee, articles about nominee, or other information that will inform the committee

Nominating materials can be emailed to or mailed 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.