Penn State Harrisburg Alumni Society's Awards Nomination Form

Please fill out the information below.

DEADLINE: February 1ST

Achievement Award 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.) 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