Golden Awards Nomination Form

The highest honor bestowed by the Minot State University Alumni Association is the Golden Award. Selection is based on outstanding service to the University or the Alumni Association and distinguished leadership in the recipient's career or community. The criteria for the Young Alumni Achievement Award is the same as the Golden Award with one exception. The nominee must be between the ages of 21-39 to receive the Young Alumni Achievement Award.

Nomination for*

Golden AwardYoung Alumni Achievement Award (Age 21-39)

Nominee Last Name*

Nominee First Name*

Mailing Address*

City*

E-mail Address

State & Zip:*

Home Phone*

Other Phone

Did the nominee attend Minot State?*

YesNo

If yes, when

Current Position*

Other Positions or Titles Held*

Connections with Minot State or Alumni Association *

Qualifications or factors to be considered for this award*

Please provide two individuals that may be contacted for personal and/or professional reference. Please include name, address, phone and email.*

Please submit this form electronicaly. If printed, please submit this form to Minot State Alumni Association, 500 University Ave W, Minot, ND 58707. If there are any questions, please email the alumni director at courtenay.brekhus@minotstateu.edu or call 701-858-3373. Thank you for your nomination.

Golden/Young Alumni Award Nomination Form