Alumni Awards 2012 Nomination Form

Please Note:

Nominations require a curriculum vitae. The CV and other support documents should be submitted electronically to Dr. Tim Schuler at tschule@tulane.edu, or hand delivered or mailed to the Tulane Department of Physics and Engineering Physics, 2001 Percival Stern Hall, New Orleans, LA 70118, Attn: Tim Schuler.
All information on a nominee must be compiled by the individual submitting the nomination. For additional information please contact Tim Schuler via e-mail (tschule@tulane.edu) or phone (504-865-5086).

For a complete description of the awards and criteria, please click here.

E-mail:

Street Address:

Phone Number:

Enter 9 digits, e.g., 504-XXX-XXXX

CITY, STATE, ZIP:

Name:

Last, First Middle Initial

Year of Graduation:

Degree Received:

Major:

Please Enter the Information Pertaining to your NOMINEE in the Fields Below.

Reasons for Nomination:

Please use this space to describe the individual's achievements and accomplishments

Nomination For:

SSE Outstanding Alumnus/a

SSE Outstanding Young Alumnus/a

SSE Outstanding Service Alumnus/a

Name:

Last, First Middle Initial

ADDRESS:

Email :

City, State, Zip:

Phone Number:

(XXX)-XXX-XXXX

Please enter your information, the NOMINATOR, in the fields below:

Reference #1 Name:

Last, First Middle Initial

Reference #1 Email:

Reference #1 Phone Number:

(XXX)-XXX-XXXX

Reference #2 Name:

Last, First Middle Initial

Reference #2 Email:

Reference #2 Phone Number:

(XXX)-XXX-XXXX