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Education for Service Award Nomination Form

The Boston State College “Education for Service Awards” are presented to graduates, professors and administrators who have demonstrated outstanding contributions in the areas of education, public service and private industry. Three to five award recipients will be selected each year by the Boston State College Steering Committee based on nominations submitted by members of the Boston State College community.

To see a list of past recipients, visit: our Alumni Relations website.

To be completed by someone other than the nominee: UMass Boston Alumni Relations Staff are available to help you complete the form. If you need assistance or have questions, please call 617.287.5344. When finished, please print form and submit to the address above.

* Required field

Nominee Information

First Name:*

Last Name:*

Nominee is: (check all that apply)* This is a required field.

Graduate Professor Administrator

Home Address

Address:*

City:*

State:*

Zip:*

Country:

Home Phone:

Mobile Phone:

Fax:

Email:*

Business Address

Address:*

City:*

State:*

Zip:*

Country:

Phone:

Your Information (Nominator)

First Name:*

Last Name:*

Phone:

Relation to Nominee:

Your Email:*

Address:*

City:*

State:*

Zip:*

Country:

Why Nominee Should Receive Award

Career/business affiliations and position titles:* This is a required field.

Professional Accomplishments/Service to Professional Organizations: (include description and specific examples of the candidate’s contributions in the areas of education, public service or the private sector).* This is a required field.

Summary: Please summarize, in 100 words or less, why this nominee is deserving of this award and their key contributions given the awards criteria. This section should briefly highlight the nominee’s strengths for the awards committee consideration.* This is a required field.

Is there anything additional you would like to say about your nominee?* This is a required field.

Please answer the question below. This is to ensure that this form is submitted by a person rather than a robot.*
Is the University of Massachusetts Boston in Massachusetts? (yes or no)