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Information for

Alumni of Honour nomination

Deadline: April 28, 2017

This form will be used to identify candidates for the School of Optometry and Vision Science's 2017 Alumni of Honour Award. Please provide as much detail as possible, point form is encouraged. Required fields are marked *

The candidate's CV, resume and/or biography including awards, journal articles, popular press articles, etc., will also be accepted and considered. Please forward to:

School of Optometry and Vision Science
University of Waterloo
200 University Avenue West
Waterloo ON  N2L 3G1
Attn: 2017 Alumni of Honour Awards

*** Privacy Statement: The University of Waterloo respects your privacy and that of the person you are nominating. Information collected here will only be used for the purposes of the award. Our privacy policy is available online or you may contact Andrea Carthew. ***

Information and privacy: questions regarding the collection of information on this form can be directed to the form administrator.

Personal Information of Nominee
Address Type * (required)
Nominee Address
Award Level
Award for consideration (choose one) * (required)
Professional Achievement

Recognizes professional accomplishments or contributions to the profession or to vision science.

What makes a good entry? Successful career/professional/research achievement(s) or contributions to the profession/field:

  • Exemplary career success, visibility
  • Significant other roles (Board of Directors, advisory groups, association committees)
  • Senior leadership
  • Known beyond industry segment
  • Leadership that has impacted the direction of the profession, affected policy, etc.

250 word maximum, point form is encouraged.

Contributions to Community

Recognizes accomplishments and involvement in volunteer leadership, humanitarian endeavours and community and public service, including or outside of optometry.

What makes a good entry? Community Service/Humanitarian endeavours:

  • Significant, sustained involvement, volunteerism, philanthropy
  • Highly visible involvement that is clearly recognized
  • Multiple leadership roles
  • Proven impact (could be local, regional, national, international)

250 word maximum, point form is encouraged.

UW Involvement, Other Information

Information that may aid in the selection process.

The candidate's CV, resume and/or biography including awards, journal articles, popular press articles, etc., will also be accepted and considered.

Letters of support are also encouraged.

250 word maximum, point form is encouraged.

Personal Information of Nominator
Address Type * (required)
Nominator Address
Are you a UW Optometry alumnus? * (required)

Please state why you are making this nomination (maximum 150 words).

Please select one of the following * (required)
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