Award Nomination Form

Nominate a deserving University of Illinois College of Medicine alumnus for one of our five College of Medicine Alumni Awards.

Our 2017 award recipients will be announced at the University of Illinois College of Medicine Homecoming Gala on Saturday, October 14, 2017.

Nominations for the 2017 Awards are due Wednesday, January 25, 2017.

COM Alumni Award Nomination Form
*Required Field
Please select an award:* 
Submission submitted by:* 
Phone:* 
Email:* 
Class Year: 
   
Name of Nominee:* 
Nominee Address (if known): 
City: 
State: 
Zip: 
Phone: 
Email: 
Class Year: 
   
Please tell us why you have nominated this individual for the award:* 

 

 



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