UCLA School of Public Health | Alumni Hall of Fame Nomination Form

2008 Alumni Hall of Fame Nomination Form

The Alumni Hall of Fame recognizes accomplishments of outstanding alumni. Please nominate an alumnus/a by completing this form and submitting it with a resume/curriculum vitae and up to three letters of support (total) to the address below.

I. Nominee

Name ______________________________ Profession ____________________

Address _______________________________________ Degree/Year ________

City ______________________ State ______ Zip _________

Day Phone _______________ Evening Phone _______________

E-mail Address ________________________________________________

II. Supporting Evidence
Please provide a current resume or curriculum vitae of the nominee and provide a letter of support that addresses one or more of the following items. Up to two additional letters are encouraged. Each letter must include the name, day telephone number, and e-mail address of its author. (See Suggestions for Letter of Support.) Each letter should contain

Career Highlights	Honors and Awards
Community Service Activities	Publications
University Service	Professional Organizations

III. Sponsor

Name ______________________________ Profession ____________________

Address ___________________________________________ Degree ________

City ______________________ State ______ Zip _________

Day Phone _______________ Evening Phone _______________

E-mail Address ________________________________________________

Please return a complete nomination packet (this form, resume/curriculum vitae and all letter[s] of support) no later than January 4, 2008 to: Alumni Hall of Fame - Nominations
UCLA School of Public Health
Box 951772
Los Angeles, CA 90095-1772
Or fax (310) 825-8440