Nomination Form

To nominate a candidate for an honorary degree, please fill out the form below or send a nomination (maximum 2 pages) via campus mail to:

Evalyn Van Allen-Shalash
Office of the Executive Vice President and Provost
111 Jessup Hall
The University of Iowa
Iowa City, IA 52242-1316

Electronic copies may be submitted to: van-allen-shalash@uiowa.edu

The deadline for nominations is Monday, February 15, 2010 .

Name of nominee:

Nominee's contact information, if available:

Nominee's connection with The University of Iowa, if any:

Area of achievement? (Please check all that apply.)

Research

Scholarship

Education

Artistic Creation

Social Activism

Human Rights

Humanitarian Outreach

Other (please specify below)

Nature of achievement:

Type or paste a statement here (maximum two pages) describing how the nominee's achievements are "extraordinary" and "sustained" over an entire career. Include any additional information that might be important in the nomination process.

Nominator Information

Your name:

Your department:

Your campus address:

Your e-mail address:

Questions? Write to Evalyn Van Allen-Shalash: van-allen-shalash@uiowa.edu