Nomination Form for Alumni Awards

Nominee: 

Class of: 

Current Address: 

City: 

State: 

Zip: 

Phone: 

Fax: 

Nomination for (please check all that apply): 

First Decade Achievement Award: 

Distinquished Alumni Award (Private Practice): 

Distinquished Alumni Award (Non-Private Practice):

Why do you think the nominee is deserving of this award? 

Person Making 
Nomination: 

Phone: 

Email: 

   All 2013 nominations must be received by: January 18th, 2013
   Awards will be presented at the UTCVM Annual Conference, February 1-3, 2013

Megan McMurray
UTCVM Alumni Relations
2407 River Drive, A301
College of Veterinary Medicine
The University of Tennessee
Knoxville, TN 37996-4550
E-mail: utcvmalum@utk.edu