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College of Public Health and Human Sciences Impact Awards
Nomination Form

The following awards are presented at the college’s annual Ovation event:

Alumni Impact Award: This award was created to recognize individuals who best personify the spirit of the CPHHS through significant, meaningful and sustained impact in their communities. The award recognizes the recipient’s professional work and community service that has made a positive, long-term impact on his/her workplace and/or community.

Preceptor Impact Award: This award honors a preceptor or internship site supervisor for his/her impactful service to the CPHHS and our students. This award recognizes individuals who best personify the spirit of the CPHHS through significant, meaningful and sustained impact of their service and contributions that benefit the career development of our students.

Supporter Impact Award: This award was created to recognize individuals who best personify the spirit of the CPHHS through significant, meaningful and sustained impact of their service to the college. This award honors alumni, donors and friends of the CPHHS who have made sustained and distinguished contributions to the college, which result in positive change.

Which Impact Award is the person being nominated for? (Click all that apply)

Alumni Impact Award

Preceptor Impact Award

Supporter Impact Award

Name of Nominee:

Information about Nominee

Address

City

State

Zip

Work Phone

Home Phone

Schools attended/dates/academic degrees:

Occupation/Profession:

Professional Accomplishments:

Oregon State University Affiliations and Activities (past and present):

Involvement with the College of Public Health and Human Sciences:

Community Involvement/Volunteering:

Other Honors and Awards received:

Additional comments:

Nominator Information

Name

Email

Mailing Address

City

State

Zip

Phone Number

Please upload a letter expressing why you are nominating this person. This is required.

Please upload any additional supporting information such as a resume, newspaper articles, letters from other family, friends or colleagues, etc. These are welcome, but not required.

When completed, please use the submit button below to register your nomination. If you have questions, please contact Veronica Royce, Alumni Relations Director, CPHHS, at Veronica.Royce@osualum.com.

Deadline for submissions: January 15, 2018