University of Cincinnati College of Medicine | Office of Alumni Affairs

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Distinguished Alumni Award - Nomination Form

Nominations for the following year’s alumni and student awards are accepted during the current year. To be eligible for consideration, completed nominations must submitted by March 15.

Nomination Form

Name of Nominee

Nominee Graduation Year

Nominee Email Address

Nominee Mailing Address

Nominee Phone Number

Nominee Employer and Position

Nominee Maiden Name (if applicable)

Reason for Nomination

Your Name

Your Email

Your Phone Number

Do you know the nominee personally?

Describe the Relationship

Letter of recommendation (include any and all relevant accomplishments, or accolades)

Add another

CV or Resume

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Contact Us

Office of Development & Alumni Affairs

College of Medicine
Medical Science Building
Suite G552
3230 Eden Avenue
Cincinnati, OH 45267

Mail Location: 0544
Phone: 513-558-5646
FAX: 513-558-0632
Email: comalum@foundation.uc.edu