Berry Alumni Association
Alumni Award Nominee Information Form
Distinguished Achievement Award

 

Last Name:   
First Name:   
Middle Name:   
Address:   
City:   
State:   
Zip Code:   
E-mail:   
Day Phone:   
Evening Phone:   
Did you graduate from Berry?   
Years attended Berry:  
Major(s):    
Minor(s):    

In addition to your letters of reference, you may only submit a maximum of five pieces of evidence to support your application.  If you choose, you may submit your resume as one of the five documents. However, please do not submit your resume in place of filling out this form. It is important that you reference these documents with the appropriate sections of the application.

1. Describe successes and/or significant leadership positions (activities, projects,etc.) you have achieved on the local level in your occupational or professional field.
 

2. Describe significant leadership positions and/or successes you have achieved above the local level (state, national, and international) in your occupational or professional field.
 

3.  Please list honors, recognitions, and awards you have received in your occupational or professional field. Please provide names of awarding organizations.
 

4.  Provide any other information to the awards committee that you believe is noteworthy.
 

References

Please list three references who may provide information regarding your achievements, involvement and career.  The references should be non-family members (alumni or otherwise).  In addition to providing the information below, please contact each reference and request a letter of recommendation be mailed directly to: Berry College, Office of Alumni Relations, Award Recommendation, P.O. Box 495018, Mount Berry, GA 30149-5018.

Reference 1:

Last Name:   
First Name:   
Middle Name:   
Address:   
City:   
State:   
Zip Code:   
E-mail:   
Day Phone:   
Evening Phone:   

Reference 2:

Last Name:   
First Name:   
Middle Name:   
Address:   
City:   
State:   
Zip Code:   
E-mail:   
Day Phone:   
Evening Phone:   

Reference 3:

Last Name:   
First Name:   
Middle Name:   
Address:   
City:   
State:   
Zip Code:   
E-mail:   
Day Phone:   
Evening Phone: