Faculty of Mathematics Alumni Achievement Medal nomination form

Please complete in as much detail* as possible and submit by April 30, 2017.

* We really appreciate the effort required to nominate someone, and want to hear about suitable candidates. If you have any doubts or questions please contact the Senior Alumni Officer for help with filling out the form, and how much information to include.

Notes:

Current or retired University of Waterloo faculty and staff are excluded.
Only complete nominations will be accepted.

Please indicate which award you are nominating for:

Alumni Achievement Award

Young Alumni Achievement Medal (under 35 years old)

Full name of nominee:

Degree(s) / year / university / subject:

E.g., Bachelor of Mathematics / 1975 / University of Waterloo / Pure Mathematics

Nominee's business details

Nominee's title:

Company name:

City:

Tell us more about the nominee

Please explain how this individual has demonstrated one or more of the following:

Outstanding professional or business contributions
Distinguished community or public service contributions
Academic excellence

Approximately 250 words recommended.

Nominated by

The selection committee may contact the nominator for further information.

Full name:

Company name:

Title:

City:

Phone (daytime):

Email:

Faculty of Mathematics Alumni Achievement Medal nomination form

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