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Distinguished Service Award Nomination Form

Please use the form below to make a nomination for the Distinguished Service Award.

* = required field

Nominee's Name*

Nominee's Home Address*

Phone

e-mail address

Class Year

Luther Degree/Major

Other Institutions/Degrees

Present Occupation/Title

Professional Positions Held

Professional Awards and Honors Received

Professional Memberships

Community/Volunteer Organization Memberships and Positions Held

Publications/Research

List any Other Reasons You Believe Your Nominee is Qualified for this Award.

Other information such as a nominee's resume or vita, or news articles about their accomplishments may be mailed to:Luther College Office of the President 700 College Drive Decorah, IA 52101 Or e-mailed to [email protected]

Your Name*

Your Address*

Your Phone

Your E-Mail Address

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Tarbaby

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Antlion

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