Aluni Society SIU School of Medicine"

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Distinguished 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 curriculum vitae and picture of the Nominee.
Name
Phone
Email
   
Name
Phone Email
     
Name  
Phone Email
     
Name  
Phone Email
 
   
 

 

 

 
Phone 217-545-7800
P.O. Box 19650
Springfield, IL 62794-9650
The mission of Southern Illinois University School of Medicine is to assist the people of central and southern Illinois in meeting their health care needs through education, patient care, research and service to the community.

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