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NYIT College of Osteopathic Medicine Annual Alumni Awards Nomination Form

This form is open year-round, but for consideration in the 2024 awards, please submit your nomination no later than Wednesday, January 17, 2024.

Alumni and friends are welcome to nominate themselves or classmates and colleagues and are welcome to nominate more than one individual. All submissions will be added to a running list and will be reviewed by the Dean’s Committee.

Please direct questions to Katie Karwoski, alumni relations specialist, kkarwosk@nyit.edu.

Nomination Form

RequiredI am nominating:

Myself

Someone else

Company or Organization

I am nominating myself

RequiredFirst Name*

RequiredLast Name*

RequiredSuffix*

RequiredPlease enter a valid email address with the format youraddress@yourdomain.Preferred Email:*

Please do not submit an @nyit.edu email unless you are faculty or staff.*

RequiredPreferred Phone*

RequiredPhone Type:

Home

Mobile

Office

RequiredStreet Address*

RequiredAddress line 2*

RequiredCity*

RequiredState/Province/Region*

RequiredPostal/ZIP code*

Click to view help for this field.Enter 00000 if not applicable.

RequiredCountry*

RequiredGraduation Year:*

RequiredDegree:*

This field is required.This value is not unique.Enter your own value*

RequiredSpecialty:*

RequiredCampus:*

If you have more than one degree from New York Tech, please provide the other degree information in the field below.*

RequiredAdditional NYIT Degree: *

RequiredEmployer Name:*

RequiredJob Title:*

Please explain why you should be considered for one of our awards. Please indicate which award you are applying for. (500-700 words max)*

RequiredSelect Award:*

RequiredRationale for nomination:*

Submit Other Award HereOther Award*

I am nominating someone other than myself

Your Information*

RequiredFirst name:*

RequiredLast name:*

RequiredPlease enter a valid email address with the format youraddress@yourdomain.Email:*

RequiredPhone Number:*

RequiredDegree(s) & Year(s) (if applicable, e.g. B.S. '89, M.S. '91):*

Nominee's Information*

RequiredFirst name:*

RequiredLast name:*

RequiredGraduation Year: *

RequiredDegree: *

This field is required.This value is not unique.Enter your own value*

RequiredSpecialty:*

RequiredCampus: *

RequiredPreferred Email: *

RequiredPreferred Phone:*

RequiredStreet Address:*

RequiredAddress line 2:*

RequiredCity:*

RequiredState/Province/Region:*

RequiredPostal/ZIP code:*

RequiredCountry:*

RequiredEmployer Name: *

RequiredJob Title: *

RequiredIn what context do you know the nominee?*

Please provide a few highlights of the nominee's qualifications and indicate which award the nomination applies to. (500-700 words max)*

RequiredSelect Award:*

RequiredRational for nomination:*

Submit Other Award HereOther Award*

I am nominating for the Community Partner Award

Your Information*

RequiredFirst Name:*

RequiredLast Name:*

RequiredPlease enter a valid email address with the format youraddress@yourdomain.Email:*

RequiredPhone Number:*

RequiredDegree(s) & Year(s) (if applicable, e.g. B.S. '89, M.S. '91):*

Company or Organization Information*

RequiredCompany Name:*

RequiredContact Name:*

RequiredContact Email:*

RequiredContact Phone:*

Please provide a few highlights of the nominee's qualifications. (500-700 words max)*

RequiredRationale for nomination:*

NYIT College of Osteopathic Medicine Annual Alumni Awards Nomination Form

Nomination Form

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