Young Alumni Council Service Award Nomination Form

	NOMINEE INFORMATION
	Last Name:
	First Name:
	Email Address:
	Phone:
	Address:
	City:
	State:
	Zip Code:
	NOMINATOR INFORMATION
	Last Name:
	First Name:
	Phone:
	Email Address:
	NOMINATION
	Statement of Nomination Describe in approximately 250 words the reasons to consider the Nominee. This statement should include a description of the activities the candidate has undertaken with respect to serving the University of Virginia. Provide specific examples of the results of the candidates contributions, including solutions to specific problems, development or support of innovative service programs, outstanding achievements or advocacy that has elevated the status of the University. The statement should contain descriptions of volunteer or paid work that has positively impacted the University of Virginia. Also describe the amount of time and other attributes of the work that the candidate has performed.
	REFERENCES
	If possible, please provide contact information for 1-2 references who could provide additional information about the nominee.
	Reference #1:
	Last Name:
	First Name:
	Email Address:
	Phone:
	Reference #2:
	Last Name:
	First Name:
	Email Address:
	Phone: