Nominator Full Name *

Nominator Phone *

Nominator Email *

Relationship to Nominee *

Nominee Full Name *

Nominee Phone *

Nominee Email *

Primary Area of Impact *

Why are you nominating this individual? What stood out to you about their work or character? *

What specific accomplishments, leadership behaviors, or community impact has this nominee demonstrated? *

How has this individual demonstrated excellence, integrity, consistency, or transformational service in their role or community? *

Explain why you believe this candidate deserves to receive this prestigious award, including how their work reflects excellence, integrity, and meaningful impact. *

I confirm that the information provided in this nomination is accurate to the best of my knowledge. *

Yes

I understand that all though I am not responsible, if the nominee is invited to continue beyond this pre-screening form, a non-refundable $125 application fee is required to proceed with the full nomination process. I further acknowledge that additional costs apply if the nominee is approved for honorary doctoral conferral, including but not limited to administrative, ceremonial, and institutional processing fees, which will be disclosed prior to final acceptance. *

Yes, I Understand.

I acknowledge that this is a pre-qualification submission only and does not guarantee selection, conferral, or invitation to complete the full application. All honorary recognitions are subject to institutional review, governance approval, and formal process.•

Yes, I Acknowledge.