Southern Illinois University School of Medicine


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Alumni Service Award

Purpose
To recognize alumni who have made an outstanding commitment to the health and welfare of their patients and their community and for humanitarian activities.

Selection Factors

Contributions to his/her local community (or broader area) in a civic, cultural or health care sense.
Expertise and contribution to the profession of medicine

Nomination and Selection

Nominations may be submitted by any alumnus/alumna, faculty or friend of the school
Selection will be made by the Alumni Society Board
Self nominations will not be accepted
Sitting members of the Board of Governors are ineligible

Eligibility
Any alumnus/alumna of SIU SOM

Nominee
Who would you like to nominate?
Please provide a detailed letter of nomination describing how the nominee ... contributes to the better health and improved quality of life for his/her patients and/or community. contributes to public understanding and appreciation of the role of medicine. contributes to the advancement of medicine and health through leadership of local, state, national or international organizations. Enter letter of nomination below.

Nominator
Nominator's Name
E-mail
Mailing Address
City	State Zip
Home Phone	area code, prefix, number
Work Phone	area code, prefix, number
Letters of Support
Please list the names, phone numbers and e-mail addresses of at least 3 people who are willing to write letters of support for this nominee. Nominator is responsible for contacting these individuals, obtaining the letters and submitting them to Alumni Affairs at the School of Medicine, along with a current CV for the Nominee.
Name
Phone		Email

Name
Phone		Email

Name
Phone		Email

Name
Phone		Email