Alumni Award Nomination Form

Fields marked with an asterisk (*) are required.

Select an Award
George Hammell Cook Distinguished Alumni Award (for alumni who earned a B.S. or B.A.)
Dennis M. Fenton Distinguished Graduate Alumni Award (for alumni who earned an M.A. or Ph.D.)
Cook Graduation Speaker
Other, please specify:
Nominee Information
Name*:
Department, Degree and Year Earned*
Home Address:
City:
State:
ZIP:
Business Address:
City:
State:
ZIP:
Phone (day):
Phone (evening):
Current Occupation:
Email:
Details
Please summarize the nominee's accomplishments with special attention to the impact of his or her work.
Significant Accomplishments*:
Supporting Documents: You may submit up to 5 pages of supporting documentation which may include: CV (short version) or resume, letters of recommendation, newspaper or magazine reprints, description of other awards and honors, or a brief biography. Attach electronic files or mail copies to: Cook Alumni Association, Awards Committee, Office of Scholarship Programs and Alumni Relations, 71 Lipman Drive, New Brunswick, NJ 08901. For more information call (732) 932-ALUM.
Nominated By
Name:
Address:
City:
State:
ZIP:
Phone (day):
Phone (evening):
Do you know the nominee personally? Yes No