2024 Distinguished Alumnus Award Nomination Form

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Recognition as a Distinguished Alumnus shall be limited to individuals, living or deceased, who have attended or graduated from Urbandale High School no fewer than 15 years previous to the nomination year and have made significant accomplishments in one or both of the following areas, while maintaining high standards in personal integrity and character:

• Outstanding leadership in their field
• Service to the community through local, state, national, and/or international organizations

Any questions can be sent to uhsawards2022@gmail.com

Name of Nominee: *

Is the nominee living or deceased? *

Living

Deceased

Nominee's Graduating Class: *

Nominee's Phone Number:

Nominee's Email Address:

Career & Professional Achievements:

Local, State, National, and/or International Contributions:

Philanthropic Contributions:

Any awards or achievements received:

Any other information you'd like to give as to why you believe this person is worthy of consideration:

Your Name: *

Your Phone Number: *

Your Email Address: *

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