Award

Please complete and submit this form. Content may be edited for style and will be sent to appropriate media. All entries are subject to verification before release.

Please type all responses in appropriate upper and lower cases. (Not all uppercase, please)

Today's date:		Month January February March April May June July August September October November December Day 01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 Year 2003 2004 2005 2006 2007 2008 2009 2010
Personal Information
First Name:		M.I.:
Last Name:
Phone Number (USA):		- -
Email:
Contact Person Information A student, faculty or staff member knowledgeable about the honor or award. This person may receive media inquiries.
First Name:		M.I.:
Last Name:
Phone Number (USA):		- -
Fax Number (USA):		- -
Email:
About the person being honored
First Name:		M.I.:
Last Name:
Street Address:
Address (Cont'd.):
City:
State (USA):		Choose One Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Washington West Virginia Wisconsin Wyoming
Province (non-USA):
Zip/Postal Code:
Country:		Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet IS. Brazil British Indian Ocean Terr. Brunei Darussalam Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman IS. Central African Republic Chad Chile China Christmas IS. Cocos (Keeling) IS. Colombia Comoros Congo Congo, Dem. Rep. of the Cook IS. Costa Rica Côte d’Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland IS. Faroe IS. Fiji Finland France France, Metropolitan French Guiana French Polynesia French Southern Terr. Gabon Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guadaloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard IS./McDonald IS. Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, North Korea, South Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall IS. Martinique Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk IS. Northern Mariana IS. Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Réunion Romania Russian Federation Rwanda Saint Helena Saint Kitts and Nevis Saint Lucia Saint Pierre and Miquelon St. Vincent/Grenadines Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon IS. Somalia South Africa S. Georgia/S. Sandwich IS. Spain Sri Lanka Sudan Suriname Svalbard and Jan Mayen Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos IS. Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States U.S. Minor Outlying IS. Uruguay Uzbekistan Vanuatu Vatican City State Venezuela Viet Nam Virgin IS., British Virgin IS., U.S. Wallis and Fortuna IS. Western Sahara Yemen Yugoslavia Zambia Zimbabwe
Title or major/class standing:
Department:
Educational Degree:
Institution:
Year:
Educational Degree:
Institution:
Year:
Educational Degree:
Institution:
Year:
Name of award/honor/appointment:
Date and occasion of presentation (if applicable):		(eg: June 1, 2003 Annual Ethnobiologists meeting)
Place of presentation (if applicable):		(eg: Hilton Conference Center, Tucson)
Do you have a photo of the honoree that can be used for the release? Yes No
How will this photo be delivered?(Pictures must be 200 resolution or better if emailed)
Describe in 250 words or less the criteria or significance of the award/honor/appointment/scholarship and a brief description of the awarding organization.
Provide in 250 words or less any comments made by the awarding organization.
Press releases are routinely sent to local media organizations and the honoree's hometown. If you would like the release to be sent to other publications, please list them.
Name of publication:
Name of publication:
Please take a moment to check over your entry. When you are satisfied with your answers press the submit button below. The information will be edited and a press release will be sent out. Thank you and congratulations on your achievement.