Alumni Hall of Fame
Nomination Form
2011 UCLA School of Public Health Alumni Hall of Fame Nomination Checklist
Nominations must be submitted in English and must include the following:
- Name, Occupational Address, Phone, Fax, and Email of nominee
- Name, Occupational Address, Phone, Fax, and Email of nominator
- Curriculum Vitae and Bibliography of significant publications of nominee
- A Narrative Statement describing the nominee's qualifications for the Award.
- A Proposed Citation - limit to 1 or 2 sentences
The 2011 Alumni Hall of Fame nomination categories are:
- The Lester Breslow Lifetime Achievement Award
- The Lester Breslow Lifetime Achievement Award recipient should embody the following:
- Innovation
- Entrepreneurship
- Community Service
- Young Alumnae/us Achievement: (graduate in the past 7 yrs.)
- The Young Alumnae/us Achievement recipient should embody the following:
- Leadership in public health community
- Entrepreneurship
- Community Service
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For more information please contact Karin Shaw:
Phone: (310) 825-5119
Email: kshaw@support.ucla.edu
Deadline is Friday, October 15, 2010.
Nominations can be submitted to Karin Shaw via:
1. Email: kshaw@support.ucla.edu
2. Campus mail: 16-080 CHS, Box 951772
3. U.S. Mail: UCLA School of Public Health
Office of Alumni Affairs
16-080 CHS, Box 951772
Los Angeles, CA 90095
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