DISTINGUISHED CITIZEN NOMINATION FORM

The Distinguished Citizen Award is presented to alumnae in good standing who have made outstanding contributions and achievements in various fields and professions in their communities. Achievements of nominees should be unique and clearly rise above and beyond all levels of expectation. Fields to be considered are: Arts, Business, Education, Government, Public Service, Religion, Science and Social Service. In addition, nominees should have some connection to Alpha Gamma Delta in their alumnae life. Nominations can be made by an alumnae chapter/club, a collegiate chapter or by an individual member of the Fraternity. Awardees are selected by International Council and the award is presented at International Convention.

BIOGRAPHICAL INFORMATION
Name of Nominee:
First Maiden Last
Mailing Address of Nominee:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Cell Phone # for Nominee:
Nominee's Email:
Nominee's Initiating chapter:
College or University:
Initiation year:
Initiated as a:
- Collegian
- Alumna
Please choose the field in which the nominee has excelled:*
EDUCATIONAL INFORMATION
Include all degree granting or certificate granting programs:
Institution Degree Date Received Area of Study
PROFESSIONAL EXPEREINCE
Include company/agency name, position, job description, dates, accomplishments and awards:
COMMUNITY/CIVIC CONTRIBUTIONS
List community activities and organizational memberships. Include dates, positions and awards:
ALPHA GAMMA DELTA
List any connections to Alpha Gamma Delta as an alumna. Please include associations with alumnae chapters or clubs.
Is the nominee a wearer of an Honor of Epsilon Pi?
- Yes
- No
- Unsure
Is the nominee an Alpha Gamma Delta Foundation donor?
- Yes
- No
- Unsure
NARRATIVE
Please provide a descriptive narrative on why this sister should be selected as an Alpha Gamma Delta Distinguished Citizen. Please explain the qualities and qualifications that make her achievements noteworthy.
SUPPLEMENTAL MATERIAL:
Please upload photos of the nominee, resume, links to articles about the nominee, etc.
File
Max. file size: 50 MB.
File
Max. file size: 50 MB.
File
Max. file size: 50 MB.
File
Max. file size: 50 MB.
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Max. file size: 50 MB.
SUBMITTED BY:
Name or group:
Address:
Street Address Address Line 2 City State / Province / Region ZIP / Postal Code Country
Phone:
Email:
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Institution	Degree	Date Received	Area of Study

DISTINGUISHED CITIZEN NOMINATION FORM

BIOGRAPHICAL INFORMATION

EDUCATIONAL INFORMATION

PROFESSIONAL EXPEREINCE

COMMUNITY/CIVIC CONTRIBUTIONS

ALPHA GAMMA DELTA

NARRATIVE

SUPPLEMENTAL MATERIAL:

SUBMITTED BY:

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