1.	For which award would you like your nominee to be considered?:

Edward A. Dickson Alumnus of the Year

UCLA Award for Professional Achievement

UCLA Award for Public Service

UCLA Award for Community Service

UCLA Award for Volunteer of the Year

UCLA Award for Network of the Year

Young Alumnus of the Year

2.	What is the name of the alumnus, alumna or network you would like to nominate?

3.	What is their grad year?

4.	Please explain why you feel your nominee is deserving of this UCLA Award. Note: Including as much detail as possible helps your nominee during the selection process.

5.	List any professional achievements or community recognition they have received.

6.	What impact has your nominee had on UCLA or their community?

7.	If your nominee is selected as a recipient, we’ll be reaching out to them to notify them of the award. What is the best phone number and email for us to use?

Phone:

Email:

8.	Please provide any supporting websites or links (3 max).

9.	Please upload any supporting documents (3 max), such as a letter of support.

Upload files here: https://alumni.ucla.edu/nominations-uploads

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Your information:

Nominator's name:

Nominator's email address:

Nominator's phone number:

Relationship to nominee: