DSA Nomination Form

Thank you for your time in submitting a Distinguished Service Award nomination. Please complete the following information as thoroughly as possible.

Nominee’s Personal Information
First name
Last name
Maiden name
Address
City
State
Zip
Phone
E-mail
Church affiliation
Reunion year	2003 1998 1993 1988 1983 1978 1973	1968 1963 1958 1953 1948 1943 other
Alumni considered for the “Distinguished Service Award” will be limited to those alumni celebrating their reunion years beginning with the 10 year reunion class, unless special circumstances warrant giving the award in a non-reunion year. The most significant attribute is a clearly demonstrated walk with Jesus Christ (‘Pro Christo’). Other pertinent data, when available, includes professional information and accomplishments, education, church affiliation and involvement, and service to country (‘et Patria’) to include civic and community activities. Another important factor for consideration is the nominated individuals’ loyalty and service to Geneva. The committee will seek to select candidates whose life accomplishments and character exemplify a balance of these categories.

Nominee’s Service
Please use this space to share about how he or she clearly demonstrates a walk with Jesus Christ.
Please use this space to share about his or her civic and community activities.
Please use this space to share about his or her service to the country.
Please use this space to share about his or her loyalty and service to Geneva College.

Nominee’s Business Information
Employer’s name
Job title
Please use this space to share any professional accomplishments of the nominated individual.

Nominator’s Personal Information (This information is required)
Name
Address
City
State
Zip
Phone
E-mail

Deadline for 2013 submission is May 31, 2013.