Berry Alumni Association
Alumni Award Nominee Information Form
Distinguished Service 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. Please list recognized services beyond occupational or professional obligations that you have rendered to others such as church, community organizations, etc. Show dates relative to each service you have provided.
    

2. Please list awards with dates, awarding organization, and criteria for each award received relating to your service.
      

3.  Please describe service of significant value that has not been recognized and did not attract public attention. Show dates relative to this type of service provided.
    

4. Since graduation or separation from Berry, list your service to Berry other than monetary contributions. This may include such things as involvement in alumni chapters, participation in alumni events, and volunteer services on various projects, and/or membership in the Berry Alumni Council.
    

5. Provide any other information relating to service that you believe is noteworthy.
     

 

References
Please list three references who may provide information regarding your service achievements and involvement.  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: